April 2020: Kaiser Permanente Update

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Telehealth Claims – Fully Insured Clients

Beginning in April 2020 Kaiser Permanente of Washington’s Care Delivery System’s implementation of coding for telehealth services went live retroactive to January 1, 2020. For many this change will have minimal to no impact as most plans have no out-of-pocket cost sharing for in-network virtual care including e-visit, Care Chat online messaging, and video and phone visits.  However, this will now create an Explanation of Benefits for members which may generate questions. For any billing questions please have members contact Member Services at 888-901-4636.

For e-visit, Care Chat, video and phone visits, members on HSA plans must first satisfy the annual deductible before coinsurance will be waived.  These plans are regulated by the IRS and do not allow coverage prior to the deductible when coded and charged to the health plan. Members of HDHP’s will be charged according to their contract language moving forward. For most this means these interactions are member responsibility until their annual deductible has been met. Following the deductible being met the services will be covered at 100% for the member.  Please note, based on state/federal mandates applicable Telehealth services related to COVID-19 are not subject to the deductible.

We apologize this notification was not sent prior to implementation. This change is to align to with our national partners, so the member experience continues to be as seamless as possible for our members between regions.

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