Blue Cross NC to Expand Telehealth Coverage Following Spike in Use

Based on a review of telehealth data from the past two years, Blue Cross Blue Shield of North Carolina (Blue Cross NC) is launching an expanded telehealth policy that will cover virtual care services for behavioral health, primary care, and outpatient visits for certain plan members.

Blue Cross NC, an independent licensee of the Blue Cross and Blue Shield Association, serves more than 4.2 million members across North Carolina.

In March 2020, Blue Cross NC implemented parity coverage, providing the same reimbursement for in-person and virtual care, including both video and audio-only visits. To assess telehealth usage during the COVID-19 pandemic, Blue Cross NC analyzed claims for all commercial plans, including the State Health Plan, in the past two years.

The analysis shows a 7,500 percent increase in telehealth claims in 2020. Telehealth visits for behavioral health and primary care services spiked to more than 2.7 million, accounting for more than 92 percent of all telehealth visits.

Further, of all in-person and virtual care claims filed in 2020, telehealth visits accounted for 47 percent of behavioral health visits, 7 percent of pediatric visits, and 2 percent of specialist visits.

The analysis also revealed that 59 medical services accounted for 99 percent of all paid telehealth claims in 2021.

"The pandemic has radically changed how members prefer to access care," said Stephen Friedhoff, MD, senior vice president of Health Care Services at Blue Cross NC, in a press release. "The substantial increase of telehealth usage during the pandemic has provided two years of member data that is more informative than the entire 20 years prior when our company first began covering telehealth. Blue Cross NC is responding to ensure our policies reflect these findings by expanding telehealth options so members can access easy, affordable care no matter where they live."

The expanded policy will take effect on Jan. 1, 2023. It will apply to Blue Cross NC fully insured and administrative services-only plans, including the State Health Plan. But it does not apply to health plan members receiving out-of-state telemedicine.

Based on the analysis, the payer has decided to cover behavioral healthcare, primary care services, and outpatient visits for the above-mentioned plans. But certain services, like surgery, laboratory testing, and radiology, will not be covered as the payer decided they could not be conducted appropriately via telehealth following conversations with providers, the press release notes.

As telehealth skyrocketed during the COVID-19 pandemic, payers took note, loosening restrictions on virtual care services and offering payment parity with in-person services.

Over the course of the pandemic, telehealth use, though relatively high, has leveled off. Still, payers view the care modality as an integral part of care delivery, with many creating new virtual-first offerings this year.

In May, CVS Health launched a new virtual care solution for eligible Aetna and CVS Caremark members to provide primary care, on-demand care, chronic condition management, and mental health services.

UnitedHealthcare began offering access to virtual physical therapy in April for members of employer-sponsored health plans with musculoskeletal issues.