What is the COVID-19 virtual visit waiver?
Some health plans and employers are temporarily waiving client payment responsibilities for virtual behavioral health sessions. For other forms of care, in-person visits, or out-of-network appointments, standard copays or coinsurance fees will apply.
What does this mean for me?
For the duration that the COVID-19 virtual visit waiver is in effect, any client who may be eligible for the waiver will not receive invoices until after the appointment’s claim has been processed, which can take up to 30–60 days after the appointment. Once a claim has been processed, there are two possible outcomes:
- If a processed claim shows that you owe $0, you will not receive an invoice for that visit.
- If a processed claim shows you have a payment responsibility, the Alma team will bill you via an emailed invoice or via Auto Pay, if enrolled.
Why was I charged for some visits but not others?
Some insurance companies have been processing the waiver inconsistently, meaning some visit claims are processed with a $0 payment responsibility and others are processing with normal payment responsibilities. As a result, you’ll receive an invoice for each claim returned to us showing that you owe a payment responsibility for your appointment, and you will not receive an invoice if your claim shows that you owe $0. Our team will invoice on a per-claim basis after the claim is processed.
Who is eligible for this waiver and when does it expire?
Some Optum (e.g., United Healthcare, Oxford, Oscar) plans may be eligible for the COVID-19 virtual visit waiver. This varies by plan and is determined by each employer’s specific benefit contract.
It is unclear how long these waivers will remain in effect. Expiration dates have been extended a number of times and vary by plan. We encourage you to contact your insurance company directly to understand whether you are eligible for the waiver and its anticipated expiration date.
What is the best way to ask my insurance company whether I’m eligible for this waiver?
When calling your insurance company to confirm your eligibility for the virtual visit waiver, we recommend using the following script and documenting the call reference number in case you want to share the outcome of the call with our team or use it to appeal a claim in the future:
“Hi. I’m calling to understand whether my payment responsibility is waived for in-network, virtual behavioral health outpatient office visits. Can you confirm what makes a plan eligible for this waiver, and whether my plan qualifies? If I am eligible for this waiver, when does the waiver expire? Finally, can I please have the call reference number for this conversation?”
How do I know if I’ll be charged for an appointment if I never get an invoice?
If a processed claim shows that you owe $0, you will not receive an invoice for that appointment. You can confirm this by reviewing your visit’s Explanation of Benefits (EOB) statement, which is sent to you after each claim is processed.
You should review EOBs regularly after appointments to ensure that your insurance carrier has processed your claim correctly. You can access these via your insurance company’s online patient portal or via paper EOBs which will be mailed to you. If you’re not sure where your EOBs are being directed, please contact your insurance carrier directly to confirm.
What if I disagree with how my claim has processed?
If you believe that a claim has been processed in error, you can appeal the claim by contacting your insurance company’s claims department directly and following the instructions outlined on the bottom of your Explanation of Benefits (EOB).
Your EOB will include instructions on how to appeal claims by mail, but our team has found success by calling the Claims Department directly. To appeal a claim by phone:
- Prepare the following information to have on hand:
- Your member ID
- Date of birth
- Name of primary policy holder, if different from your own
- Date of service in question
- What you expected to be your payment responsibility
- Call the number on the back of your insurance card and ask to speak to the Claims Department
- You may use the following script:
- “Hi, I would like to appeal the claims decision for my XX/XX/XX date of service. I believe this was processed in error and would like this to be reprocessed with my expected payment responsibility of $XX/XX%.”
- If you have a claim that processed as you had expected, it is often helpful to reference that claim. For instance, “I would like to reprocess the claim for the January 30, 2021 date of service as I believe it was processed in error. Please reference my January 15, 2021 claim for an example of how I believe the January 30, 2021 claim should have been processed.”
As the client of an Alma provider, you are responsible for all payment obligations as indicated by your insurance carrier.
What happens to my existing Alma invoice once I’ve appealed the claim?
Your invoice will remain active until you receive an updated EOB for your appealed claim and the Alma team receives confirmation that your appeal has been accepted. At that point, we’ll refund your invoice if you’ve submitted payment or we’ll void the invoice if it is still outstanding.