Lawsuit Filed Against Blue Shield Declaring Violation of Contract for Not Covering Telephonic Health Services in California

Here we go back to the same old issue here with doctors not being reimbursed for services involving teleheath.  When you call your attorney, they charge you for phone consults, right?  There are AMA CPT codes to bill for such that are available but that’s no guarantee that insurers will honor and pay. 

This lawsuit also explains a lot in the fact that it shows why physicians are hesitant to bill for tele-health services too if they are not going to get paid.  There’s all types of technologies on the market now from video conferencing to web software that completely documents an entire consult and again with the fear of not being paid, can you blame doctors for being hesitant?  Now this case references phone calls and perhaps it is due to the fact that it is not being done via computer?  That makes this case interesting in the fact that are technologies via the internet going to be paid for while phone calls are not?  It’s an interesting question here and if nothing else a phone bill could be of help in substantiating the phone call.  The California Department of Managed Care appears to agree with the findings of her lawsuit as well.  BD 

July 13 (Westlaw Journals) - An insurance policy that broadly defines medically necessary health services covers telephone consultations with health professionals unless explicitly excluded, according to a California state court class action.

The suit, filed in the San Francisco County Superior Court, alleges Blue Shield of California violates its contract and acts in bad faith by consistently refusing to pay for medically necessary telephonic health services.

Susan W. Vican filed suit on behalf of thousands of California policyholders who have had to pay for consultations done over the phone.

Vican, insured by Blue Shield since 1996, says her son, also covered by the policy, suffers from several chronic conditions that require frequent medical attention from his physicians.

In 2009 Vican approached the California Department of Managed Health Care, a state-sponsored HMO consumer rights organization, with her complaints about Blue Shield’s failure to cover the telephonic health services.

The group agreed the insurer violated its coverage terms and directed Blue Shield to pay for the telephone consultations, the complaint says.

Blue Cross wrongly denies coverage for telephonic health services, suit says

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