What is the COVID-19 virtual visit waiver?
Virtual visits are covered by some health plans and may be subject to copay or coinsurance fees that are the same as if the appointment was conducted in person. During the COVID-19 pandemic, however, some health plans and employers are temporarily waiving these fees.
The COVID-19 virtual visit waiver only applies to virtual behavioral health sessions. Eligible clients will owe $0.00 for their virtual behavioral health sessions for the duration of the waiver. For other forms of care, in-person visits, or out-of-network appointments, standard copays or coinsurance fees will apply.
Who is eligible for this waiver within Alma's insurance program?
Some Aetna and Optum (ex. United Healthcare, Oxford, Oscar, Harvard Pilgrim) 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.
The criteria required to be eligible for the waiver includes the following:
- The health insurance plan must be written within a state that is participating in the COVID19 Virtual Visit Waiver and includes the following states: New York, New Jersey, Illinois, North Dakota, and Rhode Island.
- The health insurance plan must be a fully funded plan, a plan choice that each employer makes when selecting benefits for their employees.
Because each plan is different, we encourage you to contact your insurance company directly to understand whether you are eligible for this temporary cost share waiver.
How long will the waiver remain in effect?
It is unclear how long these waivers will remain in effect. The timeline varies by insurer and plan and expiration dates have already been extended a number of times. The Alma team works to better understand these timelines in order to offer as much advance notice as possible. Again, we encourage you to contact your insurance company directly to understand the details of this waiver.
What can I expect as a client?
If you are potentially eligible for the cost share waiver, the Alma team will wait to submit an invoice for your payment responsibility until each claim has been processed. If a processed claim shows that you do not owe a copay for a particular session, you will not receive an invoice. If the processed claim shows that you owe a copay, the Alma team will charge you via an emailed invoice or via Auto Pay, if enrolled.
As the client of an Alma provider, you are responsible for all payment obligations as indicated by your insurance carrier. 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 by following the instructions outlined on the bottom of your Explanation of Benefits (EOB).