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Telehealth and ERISA

  • 1.  Telehealth and ERISA

    Posted 02-26-2021 14:05
    It has been brought to my attention that members who are caring for people with ERISA plans are being required to use the plans telehealth platforms; Teledoc is frequently mentioned. Not only is it requiring more administration and cost for provider they pay much lower reimbursement rates. Since these are Erisa plans our state department of insurance has no jurisdiction.

    We have legislation advancing right now requiring insurance companies to pay the same rates for telehealth as they do for in person but understand this legislation will not apply to Erisa plans.

    Just wondering if anyone else is hearing from members with similar concerns?


    Annette Dubas
    Executive Director
    Nebraska Association of Behavioral Health Organizations
    Fullerton NE

  • 2.  RE: Telehealth and ERISA

    Posted 02-26-2021 17:53
      |   view attached

    This is a big issue right now in PA.  After fighting the battle to expand flexibility and coverage of telehealth with Medicaid, the commercial plans have now become the barrier. In addition to ERISA, it hits any provider who accepts commercial insurance in general, plus anyone who is dually eligible- and in PA at least that is a lot of children in need of services.  What we have seen is:

    1. Simple denials of telehealth, lower reimbursements, specific provider panels, or other rules which make telehealth less feasible;
    2. Insistence on the use of proprietary software for telehealth, which creates a barrier; and as you specifically note-
    3. Insistence on teledoc.

    In essence, the governor has stated that there is a "state of emergency" and rules/ barriers are waived.  But if you are a commercial insurer, you can make your own rules.  Several even stopped expanded coverage months ago as if the "emergency" had ended.

    We have several meetings pending (e.g., Department of Insurance) in the next days/weeks to take this up.  But it has quickly become one of our leading issues.  I have attached a 1-page overview on the issue if interested. Thanks for raising.

    - Richard

    Richard Edley
    Rehabilitation and Community Providers Association
    Harrisburg PA