In many states, government orders mandate insurance coverage for telehealth during this state of emergency and specify that some patient responsibility for the visits be waived. Nevertheless, some PPS members have reported that some insurance company systems have not quickly implemented these mandates and are adjudicating claims improperly with a patient responsibility even when explicitly barred, which is requiring many claims to be reprocessed. This glitch may be happening because insurers have been removing modifiers and changing place of service (POS) codes to in office (code 11) versus telehealth (code 02) to ensure their system pays the claim, but it then triggers the insurer's incorrect application of a patient responsibility instead of waiving it per their government's order. PPS recommends that you watch your claims closely and plan to appeal if your state has a governor's or insurance regulator's order that waives the patient responsibility payment.
