Does Anthem Cover Telemedicine or Online Treatment?

Anthem, Inc. is one of the largest for-profit insurance corporations in the country. (Learn More)

Anthem defines telemedicine in pretty much the same way many states define it. (Learn More) Their plans tend to be user-friendly regarding telehealth and telemedicine services. (Learn More)

The amount of coverage you may receive for the use of telemedicine or telehealth services will depend on the type of policy you have (Learn More) and state regulations regarding telemedicine. (Learn More)

Overall, Anthem insurance policies are friendly toward online treatment, but they are restricted by state regulations and the specific policy. (Learn More) 

Anthem

Anthem, Inc. was founded as the Wellpoint Corporation in the 1940s, and it remains one of the largest for-profit health care companies in the country. It is the primary provider of Blue Cross Blue Shield services in the states where it is active.

Like other private insurance providers, Anthem is subject to the stipulations that have been enacted under the Affordable Care Act and similar legislation that designates stipulations placed on insurance providers.

Telemedicine and Telehealth

The Anthem Corporation describes telemedicine and telehealth services as the delivery of health care services via the use of audiovisual equipment or other types of interactive media for the purposes of diagnosing, consulting, or treating a patient in a location that is different from the location of the provider. The delivery of preventive measures, educational measures, or other types of non-curative types of services via this format may be covered.

Anthem specifically rules out the use of forms of electronic communication that only provide audio interactions, such as telephones and cellphones. They do not recognize the use of email or faxes as interactive forms of communication that apply to its definition of telemedicine or telehealth.

Does Anthem Cover Telemedicine Services?

The answer to this is not as straightforward as you may think. The general answer is yes, but there are some conditions regarding specific services.

Anthem covers telemedicine services through approved providers, such as LiveHealth Online, a telehealth service available in all 50 states. They may cover other approved telemedicine interactions in specific states, but coverage is subject to the stipulations of the delivery of telemedicine that are specified by the state where the provider is located (see below for more).

The coverage of telemedicine provided by Anthem is also dependent on the type of policy you have.

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Levels of Coverage for Anthem

Your coverage is dependent on the type of insurance policy you are enrolled in and the limitations or mandates of the state regarding the provision of telemedicine services within it.

Anthem offers four major levels of coverage with quite a bit of variation within each of these plans.

  • Bronze plans offer the least expensive monthly premiums, but they will typically also involve significant out-of-pocket costs. They will generally cover about 60 percent of expenses in treatment, depending on the plan and the type of treatment being delivered.
  • Silver plans will generally pay for about 70 percent of your expenses, depending on the situation, but they will also cost you a little more per month.
  • Gold plans will cover about 80 percent of your expenses but will cost you more on a monthly basis
  • Platinum plans offer the highest coverage, up to 90 percent of expenses are covered, but premiums are much more expensive. 
  • Anthem also offers health maintenance organization (HMO) plans where you must use providers within the network in order to receive coverage and preferred provider organization (PPO) plans where you can choose a provider in or out of the network offered by Anthem.

There can be variability within each plan and within each state regarding what exactly is covered, especially when you are accessing care through telemedicine or telehealth venues.

State Regulations Regarding Telemedicine Services

Your coverage for services will be subject to the type of plan you have. Telemedicine services will also be subject to regulations on telemedicine and telehealth that are active in the state where the provider is located. 

  • The majority of states still require that the physician is licensed to practice in the state where the patient is located in order to provide telemedicine services.
  • Some states issue a special license for telemedicine for physicians or other providers, and some may not allow physicians to practice across state lines.
  • Some states do not require private insurance companies to offer the same amount of coverage for telemedicine services as they do for in-person services (parity requirements).
  • Many states limit the type of services that can be delivered via telehealth/telemedicine formats.
  • Certain services may require in-person visits.
  • Telemedicine prescriptions are limited. For instance, controlled substances cannot be prescribed based only on telemedicine visits in most states.
  • Medical necessity is always a consideration in treatment coverage. This means that the treatment you are trying to obtain is deemed appropriate for you based on research studies or the standards of clinical practice.

At the time of this writing, there is a lot of variability in the regulations regarding telehealth and telemedicine from state to state. The telemedicine service you can receive will be limited by state regulations.

You can access more information on the specific regulations in your state here.

Conclusions

Anthem has attempted to make itself friendly to telemedicine services. There is a good chance that at least some of the services you require can be delivered via telemedicine and that Anthem will cover them.

The actual services or coverage you can get will be limited by your insurance policy or state regulations. If you have questions, contact Anthem’s customer service department.

References 

Anthem. (2019). Anthem, Inc. 

About the Affordable Care Act. (December 2017). U.S. Department of Health & Human Services. 

Telehealth Offers Convenient Alternative to Office Visits. (December 2016). Anthem, Inc. 

Tips for Choosing Between the 4 Levels of Affordable Care Act Plans. (October 2017). Anthem, Inc. 

Telemedicine Policies. Federation of State Medical Boards. 

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