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Blue Cross NC to cover telehealth for behavioral health, primary care, outpatient services

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

Beginning January 1, Blue Cross NC will cover telehealth services for behavioral health, primary care and outpatient care. But it will not cover services that are not appropriate or cannot be provided virtually, such as laboratory testing and radiology.

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

Jami Sowers, Blue Cross NC senior communications advisor, said the changes were made to become more representative of telehealth demands.

“We aim to ensure our telehealth policy reflects findings from this period of increased telehealth usage by expanding options so members can access easy, 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. Total member telehealth visits for behavioral health and primary care reached more than 2.7 million in 2020, representing 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 OB/GYN visits and 2% of specialist visits.
  • In 2021, 59 medical services represented 99% of all paid telehealth claims.

Blue Cross NC’s data reflect overall trends in the healthcare industry. Telehealth use soared at the start of the pandemic, but has since tapered off, according to Kaiser Family Foundation. However, it is still higher than it was pre-pandemic, and mental health usage for telehealth has remained steady

“The pandemic has radically changed how members prefer to access care,” said Dr. Stephen Friedhoff, senior vice president of Health Care Services at Blue Cross NC, in a news 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.”

Photo: elenabs, Getty Images

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