Blue Cross NC to Cover Telehealth for Behavioral Health, Primary Care, Outpatient Services - MedCity News

Behavioral health care, primary care and outpatient visits accounted for more than 97 percent of telehealth complaints received by BlueCross BlueShield of North Carolina (Blue Cross NC) over the past two years, according to recently released data data. In response to the findings, the payer will update its telehealth coverage.

Beginning Jan. 1, Blue Cross NC will cover behavioral health, primary care and outpatient telehealth services. But it won’t cover telehealth services that have been shown to be less effective when delivered virtually, such as lab tests and radiology.

The new coverage policy will be applicable to all fully insured Blue Cross NC and Administrative Services Only (ASO) plans. This includes the State Health Plan. However, this does not cover Blue Cross NC members who receive telehealth services from providers outside of North Carolina.

Jamie Sowers, senior communications advisor for Blue Cross NC, said the changes were made to make them more representative of telehealth requirements.

“We are committed to ensuring that our telehealth policy reflects the findings of this period of increased telehealth use by expanding options so members can access easy and affordable care no matter where they live,” Sowers wrote in an email to MedCity News.

Additional findings from the claims data include:

  • In 2020, Blue Cross NC saw a 7,500% increase in telehealth claims. The total number of telehealth member visits for behavioral health and primary care reached more than 2.7 million in 2020, accounting for more than 92% of all telehealth visits.
  • For all in-person and virtual claims in 2020, telehealth visits were 47% of behavioral health visits, 10% of family medicine visits, 9% of primary care visits, 7% of pediatric visits, 4% of at an obstetrician/gynecologist and 2% of visits to a specialist.
  • In 2021, 59 medical services accounted for 99% of all paid telehealth claims.

Blue Cross NC’s data reflects general trends in the healthcare industry. The use of telehealth jumped at the beginning of the pandemic, but has since declined, according to Kaiser Family Foundation. However, it is still higher than it was before the pandemic, and the use of mental health for telehealth has remained stable.

“The pandemic has radically changed the way members prefer to access care,” said Dr. Stephen Friedhoff, senior vice president of healthcare at Blue Cross NC, in a news release. “The significant increase in telehealth use during the pandemic has provided two years of member data that is more informative than the entire 20 years prior to 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 and affordable care no matter where they live.”

Photo: elenabs, Getty Images

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