The popularity of telemedicine with both providers and patients is causing many insurance providers and state governments to take note. We foresee a future in which video visits will be uniformly covered just like in-office visits, but we’re not there yet. Telemedicine reimbursement still varies from state to state and insurance plan to insurance plan. Whether your Cigna patients are covered will depend on their plan and their state.
The governments of 28 states have recognized that telemedicine has an important role to play in healthcare delivery in the US. That’s why they have passed laws requiring private payers to reimburse healthcare practices for certain encounters that leverage telehealth technology. Ten other states have legislation in process to join them. Cigna and other insurance companies are subject to this requirement for most plans. Some states exempt small group plans and worker’s compensation plans.
In many states, the laws stipulate that providers get the same amount of reimbursements for a video visit as an in-person one of the same type. Other states let the payer determine the exact amount of reimbursement.
Each state law also spells out the types of telemedicine that are covered. Every state that has such a law includes video visits. Several also cover store-and-forward telemedicine, but this is less common, and most do not include audio only calls.
Unlike Humana, United Health, and Blue Cross Blue Shield which each have very progressive telemedicine programs, Cigna takes a more conservative approach. Coverage for video visits is determined by the patient’s state and plan details.
If you are in a state with a parity law, there’s a good chance, but not a guarantee that you can get reimbursement for a video visit with a Cigna patient. If your state does not have a reimbursement requirement, such a claim is likely to be denied.
Cigna’s approach to telemedicine reimbursement makes it challenging to predict which claims will be covered. That’s why it is smart for practices to look for telehealth software with baked-in verification of eligibility.
The Chiron Health Rules Engine® is the industry’s most accurate reimbursement verification solution available. We employ a team of claims experts to keep track of regulations and payer policies. They constantly improve the system by adding the latest information. Every time a member of your staff schedules a video visit, the Chiron Rules Engine assesses the patient’s coverage and determines whether a telemedicine encounter will be reimbursed.
The Chiron Rules Engine® is a powerful tool for eligibility verification, but Chiron Health goes beyond technology, giving you access to a dedicated team of telemedicine reimbursement specialists who can work on your behalf to address the more complicated reimbursement situations. We’ve processed thousands of claims and use that experience to help guide your team through the red tape, saving hours on the phone with Cigna.
When it comes to eligibility verification, Chiron is happy to put our money where our mouth is. We offer the Chiron Reimbursement Guarantee®. If a claim for a visit that we verify is ever denied by Cigna, we’ll work directly with them to resolve the issue. If Cigna does not reimburse for the claim, we’ll pay you for the encounter ourselves. We can make this guarantee because every time the Chiron Rules Engine® completes an eligibility check it gets smarter and we do it thousands and thousands of times.
Video visits are popular with patients and a great way to grow your practice revenues. Coverage under Cigna varies, so it will pay off to select a telemedicine software solution that can accurately and easily verify coverage for patients with Cigna. With the Chiron Guarantee, there’s no risk to you and no reason not to get started today.