Telehealth from March 6, 2020 to Present

Per the Center for Medicare Services (CMS) provisions to date (1135 waiver as of March 17, 2020):

Telemedicine” benefits by Medicare are now covering patients who utilize healthcare providers by audio/visual devices (aka “face time”).

Telephone” visits also have modest amounts of coverage.

CMS is also offering to waive copays and coinsurance for these visits at this time.

CMS has also temporarily waived the strict HIPAA regulations that previously disallowed cellphone apps. By doing this they have rapidly improved access to care for seniors.

Medicare Telemedicine Fact Sheet

Commercial insurers (ex. BCBS, UHC, Cigna, Humana, Aetna, etc) are following their lead but with rules depending on the insurer.

Please contact your insurance to see if you are “covered” for the following services we will be offering during this time and if copays and deductibles apply.

BCBS telephone visits as of 3/10/20-present

BCBS telemedicine visits as of 3/19/20-present

UHC telemedicine visits as of 3/19/20-present

Humana telemedicine visits as of 3/10/20-present

Aetna telemedicine visits as of 3/19/20-present

Cigna telemedicine visits as of 3/19/20-present

Telehealth Codes and typical insurance discounted charges:

Virtual visit code G2012-

Brief phone (no visual/face time) check in with a provider.

Copays and deductibles may apply. Typical cost (varies by insurer) $15-$50

Virtual visit code G2010-

Brief interchange with a provider by sharing an image or test results (eg. By text or email). Copays and deductibles may apply. Typical cost (varies by insurer) $15-$50

Telemedicine visit-

Usual office visit code 99201-99215 is applied in the same way as in the clinic setting. This is a complete office visit with a provider, minus the physical exam, using an electronic real time “face time” device. We will be using our laptops and work stations with applications for this service. Copays and deductibles may apply. Typical cost (varies by insurer) $70-$340 for time based coding.

Services provided and billed by our practice:

Telemedicine visits are available daily.

Our Highland Park office is open for in-person care at this time. If Illinois regresses their "Phase" designation, we will reorganize our schedule to accommodate more telehealth.

We will be performing “virtual visits” by a provider as the need arises for quick questions coming in via phone and will bill your insurance accordingly.

For established patients, we will continue courtesy nursing triage by phone for routine questions or action plan review. If provider input is required to answer a triage question by phone or change an action plan, applicable telephone services will be charged and submitted to your insurance plan.

Telemedicine visit expectations:

We will be scheduling “telemedicine” office visits in the usual way, as if you were scheduling a visit to our clinic, but will invite you via email with a link to join a "telemedicine" video call at your appointment time. The encounter will proceed much like an office visit, with receptionist verification of insurance and demographics, followed by technician triage questions, followed by a medical history taken by the physician assistant, followed by our usual assessment and plan discussion and teaching points. Written action plans will be sent by email at the conclusion of the visit. For commercial insurance and self pay, we will ask for a $60 deposit at the time of service. Deposit will be put toward patient responsibility or refunded if paid in full by the insurance company.

Shot patient routine visit expectations:

Due to insurance rules, routine "vial check" appointments will be scheduled as a telehealth or in-person visit on a separate day from your injection.

Please call to schedule your appointment and we will advise which appointment type is appropriate.

As insurance rules are changing by the day, we will try and keep this page current.