Paying with Insurance

1

Step 1:
Patient pays provider’s fee

2

Step 2:
Provider checks insurance coverage

3

Step 3:
If covered by insurance,
provider refunds patient

Does my insurance cover an online visit?

An online visit submitted to your provider on HealthLens is considered asynchronous telemedicine and is covered by most medical insurance policies.

Aetna, Blue Cross Blue Shield, Cigna, Humana and United Healthcare cover asynchronous telemedicine visits; however, coverage is dependent on the type of plan you have so check with your insurance carrier.

The most commonly used CPT codes for asynchronous telemedicine are 99203 GQ & 99213 GQ.

Why do I have to pay a fee upfront if my insurance covers telemedicine?

Your provider cannot immediately determine if your insurance plan covers asynchronous telemedicine. The upfront fee is used as a deposit until your insurance pays the provider for the online visit.

After you submit an online visit and pay the upfront fee, your provider will then bill your insurance carrier. Once the insurance payment has been received, your provider will issue you a refund for the upfront fee minus your copay or coinsurance.

If you have not met your deductible, the upfront fee will be applied to your deductible and no refund will be issued.

Some providers may not accept insurance for online visits so make sure to check your provider’s insurance participation on his/her profile page before submitting an online visit.

How is my refund amount determined?

Your refund amount is determined by your plan’s deductible, and coinsurance or copay. If your plan has a deductible that has not yet been met, you will be responsible for the full amount of the provider’s upfront fee and therefore not entitled to a refund.

If your plan has no deductible or your deductible has already been met, the provider will issue a refund in an amount equal to the upfront fee less your coinsurance or copay.

For example:

  • If a provider’s upfront fee is $65 and you have a 20% coinsurance, the provider will issue you a $52 refund since you are responsible for $13 (20%) of the upfront fee
  • If a provider’s upfront fee is $65 and you have a $20 copay, the provider will issue you a $45 refund since you are responsible for $20 of the upfront fee

When can I expect to receive my refund?

It can take up to 4–6 weeks for your provider to bill your insurance and issue a refund. You will be notified via email when your provider has issued a refund.

If more than six weeks have passed since your online visit was completed and you still have not received a refund, we recommend contacting your provider’s office directly.