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Commercial Payer Policies

*new update as of April 2021* Telehealth includes audio-only for the delivery of behavioral health services for an established patient (applies to Medicaid and private payers). 

*new update as of April 2021* The originating site is any location where the patient is located (applies to Medicaid and private payers).

*new update as of April 2021* Consent for telehealth services can be given verbally during the initial telehealth consultation, provided a signed statement is collected within ten days (applies to Medicaid and private payers).

*proposed update* Require health plans to provide (upon request) a description of the telehealth & telemonitoring services covered under their plan.

TELEHEALTH DEFINITION: “The use of medical information electronically exchanged from one site to another, whether synchronously or asynchronously, to aid a health care provider in the diagnosis or treatment of a patient.” Services may originate from the patient’s home.

SERVICE PARITY: Insurers cannot exclude services from coverage solely because they are delivered via telehealth

*new update as of April 2021* PAYMENT PARITY: Insurers cannot place greater financial burden on beneficiaries for accessing

Temporary COVID-19 Policies (NE Commercial Payers)

WAIVED REQUIREMENTS: The requirement for written consent from patients before initiating telehealth is suspended. Insurers cannot deny claims for telehealth service based solely on lack of a signed written agreement.