Therapy Copay

Posted : admin On 1/29/2022

. A copay applies for any care received for a medical condition that’s treated or monitored during a preventive visit. We follow the Centers for Medicare & Medicaid Services (CMS) Medicare coverage and coding guidelines for all. Copay Occupational Therapy Services. Copay Physical Therapy and Speech and Language Therapy Services. Ground Service (one-way trip) $240. Copay Air Service (one-way trip) 20%. Prescription Drugs. Medicare Part B Drugs. Medicare-covered Part B Drugs may. Here are the new numbers for Medicare premiums, deductibles, and copays for 2021. Most people don't pay a monthly premium for Medicare Part A (hospital insurance). But if you have to pay for Part A because you or your spouse don't have a long enough work history, you'll pay between $259 (for 30-39 work credits) and $471 (for fewer. Under certain health plans, copayments for physical therapy services, some exceeding $60 per visit, also can exceed the reimbursement paid by the plan to the provider of care. High copayments for physical therapy are one reason that some consumers opt to reduce their frequency of treatment or forgo medically necessary care.

Basic Option
Preventive Care Nothing for covered preventive screenings, immunizations and services
Physician Care

$30 for primary care1
$40 for specialists1

Virtual doctor visits by Teladoc®

$0 for first 2 visits
$15 all additional visits

Urgent Care Center $35 copay
Prescription Drugs Preferred Retail Pharmacy:
Tier 1 (Generics): $10 copay
Tier 2 (Preferred brand): $55 copay2
Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2
Tier 4 (Preferred specialty): $65 copay2
Tier 5 (Non-preferred specialty): $90 copay2
Mail Service Pharmacy:
Available to members with Medicare Part B primary only. Visit the Medicare page for more information.
Tier 1 (Generics): $20
Tier 2 (Preferred brand): $100 copay
Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy:
Tier 4 (Preferred specialty): $85 copay2
Tier 5 (Non-preferred specialty): $110 copay2
Maternity Care $175 inpatient
$0 outpatient
Hospital Care

Inpatient (Precertification is required): $175 per day; up to $875 per admission

Outpatient: $100 per day per facility1

Surgery

$150 in an office setting1

$200 in a non-office setting1

ER (accidental injury)

$175 per day per facility

ER (medical emergency)

$175 per day per facility

Lab work (such as blood tests) $0 copay1
Diagnostic services
(such as sleep studies, CT scans)

Up to $100 in an office1

Up to $150 in a hospital1

Chiropractic Care $30 per treatment; up to 20 visits per year
Dental Care $30 copay per evaluation; up to 2 per year
Rewards Program

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Copay

Many insurance companies are currently waiving copays and deductibles for telehealth; while some are waiving these fees for all telehealth services, others are limited to COVID-19 related treatment only, and many require that the provider use the insurer’s preferred telemedicine platform.

Below is a list of health insurance companies, indicating which companies are waiving copays, coinsurances, and deductibles, and if so, when they will return to regular coverage. Most health insurance companies have not released updates since they first made changes in March, but we're keeping a close eye on the situation and will share updates as we have them!

For the latest information, we encourage you to visit the linked sources, which will take you to the health insurance company's relevant press release.

Please note that specifics vary across plans, especially employer-issued plans.

Cost-Sharing Waivers By Health Insurance During COVID-19

Aetna

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. For all Commercial plans, cost sharing will also be waived for real-time virtual visits offered by in-network providers.
  • Applicable plans: Applies to all Aetna plans; self-insured plan sponsors can opt out.
  • Description: Until at least June 4th, 2020, Aetna will waive member cost sharing for any covered telemedicine visits — regardless of diagnosis. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. Cost sharing will also be waived for real-time virtual visits offered by in-network providers (live video-conferencing and telephone-only telemedicine services) for all Commercial plan designs. Members may use telemedicine services for any reason, not just COVID-19 diagnosis. Self-insured plan sponsors will be able to opt-out of this program at their discretion.
  • Notes: If clients have self-insured plans, it is important to check that the plan has not opted out of the program.
  • Sources: Source one, Source two

Allways Health Partners

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists.
  • Applicable plans: Not explicitly indicated.
  • Description: AllWays Health Partners is removing cost-sharing (copayments, deductibles, or coinsurance) for testing and copayments for treatment at in-network facilities; ensuring access to out-of-network providers for the initial COVID-19 test or treatment when no in-network providers are available; and removing all cost-sharing for telemedicine services, including virtual visits with primary care providers and specialists, and through Partners HealthCare On Demand, to enable members to seek COVID-19-related care without the need to go to medical offices... There will be no cost to you for telemedicine (including telephone) visits for standard/routine outpatient behavioral health.
  • Sources:Source

Anthem

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: Applies to all Anthem affiliated plans; self-insured plan sponsors can opt out.
  • Description: For 90 days effective March 17, 2020, Anthem’s affiliated health plans will waive member cost shares for telehealth visits, including visits for mental health or substance use disorders, for our fully-insured employer plans, individual plans, Medicare plans and Medicaid plans, where permissible. Cost sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers delivering virtual care through internet video + audio services. Self-insured plan sponsors may opt out of this program.
  • Sources:Source

Blue Cross Blue Shield Association

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All 'fully-insured' members
  • Description: 'All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services. We are also advocating for physician and health system adoption of social distancing-encouraged capabilities such as video, chat and/or e-visits. This builds on the commitment we previously announced to ensure swift and smooth access to care during the COVID-19 outbreak.'
  • Sources:Source

Blue Cross Blue Shield of Massachusetts

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All members
  • Description: 'Blue Cross has waived member cost share (co-pays, co-insurance and deductibles) for all medically necessary medical and behavioral health covered services, via phone or video (telehealth) with in-network providers if such services are offered.'
  • Sources: Source

Blue Cross and Blue Shield of Illinois

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All BCBSIL members with telemedicine/telehealth benefits in their plan (excluding Part D plans for Medicare members)
  • Description: 'Currently, if you are insured by BCBSIL, including Medicare (excluding Part D plans) and Medicare Supplement members, you can: Access provider visits for covered services through telemedicine or telehealth as outlined in your benefit plan. You won’t pay copays, deductibles, or coinsurance on in-network covered telemedicine or telehealth services.'
  • Sources: Source

Blue Cross and Blue Shield of Rhode Island

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All members
  • Description: Expanded coverage for clinically appropriate telehealth services that are provided by any in-network provider through permitted means, including telephone and audiovisual technologies. Permitted audiovisual capabilities include nonpublic video conferencing such as Skype, Google Hangouts and FaceTime. Waived all member cost sharing (copays and deductibles) for telehealth whether provided by an in-network provider or through the Doctors Online telehealth platform.
  • Sources: Source

Blue Shield of California

  • Cost sharing waived for teletherapy? Yes, but only for Teladoc Services
  • Applicable providers: Only waiving costs for Teladoc Health virtual care service.
  • Applicable plans: Applies to Blue Shield’s Individual and Family Plans, Medicare Supplemental plans, Medicare Advantage plans, as well as employer- and union insured plans.
  • Description: 'Blue Shield previously announced it is waiving prior approval and copayments for Teladoc Health virtual care service through May 31, 2020 for most of its members. Not all plans have access to these services.'
  • Sources:Source

Cigna

  • Cost sharing waived for teletherapy? No (only for categories of 'screening, diagnosis, or testing' for COVID-19)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'Effective today, Cigna is waiving customer cost-sharing for all COVID-19 treatment through May 31, 2020. The treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations. The company will reimburse health care providers at Cigna's in-network rates or Medicare rates, as applicable. Will Cigna cover Coronavirus virtual care visits? Yes. If your visit is related to screening, diagnosis, or testing for the Coronavirus, your out-of-pocket costs will be waived.'
  • Sources: Source

ConnectiCare

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network
  • Applicable plans: All members
  • Description: 'Today, ConnectiCare, one of the region’s leading health plans, announced that members can temporarily use telehealth for covered medical and mental health services at no cost. To make it easier for our members to get the care they need, ConnectiCare is eliminating the financial burden associated with office visits by covering telehealth appointments for any reason.' The company is allowing no-cost member real time visits with medical and mental health professionals by phone, computer, and mobile app.'
  • Sources:Source

EmblemHealth

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network
  • Applicable plans: All except potentially not ASO plans
  • Description: 'EmblemHealth members across all our product lines will have no cost sharing (including copayments, coinsurance, or deductibles) for in-network telehealth visits. These visits have no cost-sharing for COVID-19 and non-COVID-19 related services. Members with a benefit plan that includes the Teladoc™ program will also have no cost-sharing for Teladoc visits. The telehealth cost-sharing waiver may not apply to ASO plans.'
  • Sources:Source

First Choice Health

  • Cost sharing waived for teletherapy? No (only for virtual primary care service, not teletherapy)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'To help ensure people will have access to a doctor during the current COVID-19 crisis, First Choice Health (FCH), a leading provider-owned healthcare administrator in the Northwest, has announced that it is covering the cost of telehealth services for its self-funded employer customers via on-demand primary care service 98point6.'
  • Sources:Source

Harvard Pilgrim Health Care

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network
  • Applicable plans: Members on individual and group fully insured plans
  • Description: All telemedicine services: Covered in full (no copays, deductibles or coinsurance)
  • Sources: Source

Healthfirst

  • Cost sharing waived for teletherapy? No (only COVID-19 related testing and evaluation)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'Healthfirst is waiving co-pays for all diagnostic testing and evaluations related to coronavirus.'
  • Sources: Source

HealthPartners

  • Cost sharing waived for teletherapy? No (only COVID-19 related testing and diagnosis)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'If you’re a HealthPartners member, you have coverage with no member cost sharing for COVID-19 testing and diagnosis. This includes the cost of the care visit associated with testing.'
  • Sources: Source

Kaiser Permanente

  • Cost sharing waived for teletherapy? No (only COVID-19 related screening and testing fully covered)
  • Applicable providers: N/A
  • Applicable plans: N/A
  • Description: 'We’re proactively extending the use of telehealth appointments via video and phone where appropriate. As a Kaiser Permanente member, you won’t have to pay for costs related to COVID-19 screening or testing if referred by a Kaiser Permanente doctor. If you’re diagnosed with COVID-19, additional services, including hospital admission (if applicable), will be covered according to your plan details.'
  • Sources: Source

Magellan Health

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: All members
  • Description: 'As the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) guidance came out on Tuesday, Magellan was revising its operations to permit all credentialed and contracted behavioral health providers to conduct telehealth video sessions for all routine services and certain psychological testing, applied behavior analysis (ABA), intensive outpatient programs (IOP) and partial hospitalization program (PHP) services. Providers are able to use a number of HHS OCR-approved platforms to conduct their telehealth video sessions. Magellan is also allowing telephone-only sessions when a member has no access to a video platform. These alternative approaches will be covered to ensure members get the care they need, when they need it. Our experienced behavioral health network providers are available to serve the needs of our clients’ members through a variety of avenues. We are proud of our network providers and look forward to working with them to support those who may need mental health services as a result of the COVID-19 outbreak.'
  • Sources: Source

Neighborhood Health Plan of Rhode Island

Copay
  • Cost sharing waived for teletherapy? Yes, but only for Optum-based virtual visits
  • Applicable providers: Optum virtual visits only for behavioral health
  • Applicable plans: All members
  • Description: 'Neighborhood’s behavioral health partner Optum, offers virtual visits so you can receive confidential care without leaving your home. For more information on accessing virtual visits, go to live and work well to locate providers and schedule an appointment with them online. Neighborhood has expanded telemedicine coverage for all members to include clinically appropriate and medically necessary services to support you not having to go into your doctor’s office, urgent cares or emergency rooms during the time of the Governor’s executive order. If your plan usually has co pays, deductibles or other cost-sharing, you will not need to pay for the services outlined below. Primary care physicians All Medical Specialists – defined as any MD, DO, NP and PA Optometrists Doctors of Podiatric Medicine (DPM’s) Lactation Consultants Physical, Occupational, and Speech Therapists Diabetes Educators Nutritionists Midwifes Urgent Care Centers Emergency Departments Retail Based Clinics'
  • Sources: Source

Oscar

  • Cost sharing waived for teletherapy? No; standard cost sharing rules apply for teletherapy
  • Applicable providers: Offering Oscar's Doctor on Call for 'most members' free of charge
  • Applicable plans: Varies depending on details of individual plans
  • Description: 'In addition to offering Oscar's Doctor on Call services to most members for $0, Oscar will cover all COVID-19 care delivered via telemedicine at $0 for our members through May 10. We will re-evaluate this date as needed. Oscar will also cover telemedicine care, consistent with our plan terms, for our members when they see an in-network provider through May 10. Standard cost-sharing rules will apply in all states except New York and New Jersey. In these states, members will pay $0 for any medically-necessary telemedicine visit with an in-network provider.'
  • Sources: Source
Physical

Premera Blue Cross

  • Cost sharing waived for teletherapy? No; only through certain platforms
  • Applicable providers: Specific services only (Talkspace for therapy)
  • Applicable plans: Varies depending on 'participating groups'
  • Description: 'To ease the burden for our members, we will waive copays, deductibles, and coinsurance for COVID-19 related treatment (both inpatient and outpatient). This waiver will continue through October 1, 2020 for participating groups. We've expanded options for you: Call your in-network primary care doctor's office. 24-Hour NurseLine is available at no charge. Just call the number on the back of your member ID card to reach medical professionals. Doctor On Demand is a video chat with a doctor. 98point6 is a text-based primary care app. Talkspace offers virtual access to licensed therapists.'
  • Sources: Source

UnitedHealthcare

Therapy Copay Waived

  • Cost sharing waived for teletherapy? Yes
  • Applicable providers: All in-network therapists
  • Applicable plans: Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans
  • Description: 'Starting March 31, 2020 until June 18, 2020, UnitedHealthcare will now also waive cost-sharing for in-network, non-COVID-19 telehealth visits for its Medicare Advantage, Medicaid, Individual and Group Market fully insured health plans. Again, we will work with self-funded customers who want us to implement a similar approach. The company previously announced we would waive cost-sharing for telehealth visits related to COVID-19 testing, in addition to waiving cost-sharing for 24/7 Virtual Visits with preferred telehealth partners.'
  • Sources: Source

Medicare coverage

For the duration of the Public Health Emergency (PHE) declared by the Secretary of Health and Human Services, CMS will be making these changes. The main note is that there will no longer be a limit on the originating site -- the place where a client or patient is receiving care. Clients can now temporarily receive telehealth visits in their home, regardless of whether they are located in a rural area.

Waived Cost End Dates

Insurance companies are planning to waive fees until the dates listed below. They will be re-evaluating and updating these dates as the situation progresses.

  • Aetna: June 4, 2020 (source)
  • Anthem: June 15, 2020 (source)
  • Cigna: May 31, 2020 (source)
  • Blue Cross Blue Shield: June 15, 2020 (source) ('All 36 independently-operated BCBS companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®) are expanding coverage for telehealth services for the next 90 days. The expanded coverage includes waiving cost-sharing for telehealth services for fully-insured members and applies to in network telehealth providers who are providing appropriate medical services.' 90 days from the publication date of this press release of March 19th, 2020, takes us to about June 15th, 2020 (calculation), which is how we arrived at this end date.)
  • Empire Blue Cross Blue Shield: June 15, 2020 (or “as long as the COVID-19 emergency is in effect.”) (source)
  • UnitedHealthcare: June 18, 2020 (source)

Grow Your Practice With Zencare!

We're looking for clinically excellent and compassionate therapists and psychiatrists to refer clients to. We'd love to learn about your practice!

Medicare Physical Therapy Copay