As part of the commitment AmeriHealth has to providing superior access to
care, we are introducing a new telemedicine strategy for 2016. As the modern
digital revolution takes hold, AmeriHealth is creating the opportunity for
convenient, effective, and affordable health care solutions via digitized
channels and virtual experiences. We are committed to expanding access to
primary care, while addressing the diverse needs of our members, ensuring they
receive quality health care services at affordable prices.
In the spectrum of care available to members, AmeriHealth considers
telemedicine to be an option that enhances access for members, as does our
network of retail health clinics and urgent care centers. Therefore,
AmeriHealth is offering ?value-added? telemedicine options for members when
they otherwise may not be able to see a provider in person. It is important to
note that the telemedicine solutions described below are not intended to
replace the member?s relationship with their primary care provider. For
emergencies, members should continue to be directed to the nearest emergency
room/department (ER).
Outlined below is the AmeriHealth approach to telemedicine for our
commercial members.
Telemedicine for primary care (AmeriHealth
Pennsylvania commercial members only)
As introduced in the December 2015 edition of Partners in Health
UpdateSM, AmeriHealth Pennsylvania now covers telemedicine
encounters for our commercial members seeking primary care services from
primary care providers (family medicine, internal medicine, general medicine
and pediatric medicine) who offer telemedicine services as an additional method
of delivery. These encounters allow our members to interact with primary care
providers using a HIPAA-secure audio/visual system that allows members and
providers to see and hear one another in real time. For specific coverage
information, please review Claim Payment Policy #00.10.41: Telemedicine for
Primary Care Services, which is available on our Medical Policy Portal. Select Accept and Go to Medical
Policy Online, and then the Commercial tab from the top of the page.
Type the policy name or number in the Search field.
Benefits include:
- Gives primary care providers the ability to communicate with their patients
in the event that an in-person encounter is not possible.
- Provides a more cost-effective option than visiting an ER, retail health
clinic, or urgent care center for non-emergency medical conditions.
- Offers care after normal business hours, including nights, weekends, and
even holidays (availability may vary).
National vendor telemedicine ?value-added?
coverage (AmeriHealth New Jersey commercial members only)
AmeriHealth New Jersey has contracted with MDLIVE®, a
national vendor that connects individuals to board-certified physicians via
HIPAA-secure video, telephone, or mobile app 24/7/365. These physicians can
diagnose medical conditions, provide short-term treatment plans, and may
prescribe medications for non-emergency medical conditions. The member can get
information on physician profiles, check appointment availability, and schedule
an appointment with the physician of their choice. The member may request a
copy of the medical records from these telemedicine encounters to share with
their primary care provider. Benefits include:
Benefits include:
- Offers members $0 cost-sharing (i.e., copayments, coinsurance, and
deductibles).
- Provides an alternate care option for non-emergency medical conditions when
it?s not possible to visit an ER, retail health clinic, or urgent care
center.
- Allows members to access non-emergency medical care while traveling*.
*Due to state regulations, telemedicine services are not
availa ble in the state of Arkansas.
Proper utilization
Telemedicine improves access to care but doesn?t always replace an in-person
visit with a physician. Here are some examples of when it?s appropriate to
utilize telemedicine:
- As an alternative for the ER, retail health clinic, or urgent care center
for a non-emergency medical issue. Some ideal situations for utilizing
telemedicine include: allergies, asthma, colds, ear infections, rashes, insect
bites, sinus infections, sore throats, and urinary tract infections.
- To request a prescription, when appropriate. Members utilizing telemedicine
can obtain prescriptions for non-narcotic medications (not controlled
substances) that in most cases can be sent directly to the pharmacy of their
choice.
- When it is not convenient to leave home or work.
As telemedicine continues to evolve and expand and as the technology
improves, AmeriHealth will keep you up to date with relevant changes to our
policies and benefits. If you have any questions, please contact your Network
Coordinator or Provider Partnership Associate.