Kaiser Permanente 2020 Sample Fee List. Then you’ll start paying less — a copay or a percentage of the charges (a coinsurance) for the rest of the year. Depending on your plan, you may pay copays or coinsurance for some services without having to reach your deductible. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this 'Cost Sharing' category: Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the initial coverage phase for a 30-Day supply (until your total retail prescription drug.
Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. COVID-19 cases had just exceeded 5,000 in Texas, where she lives.
Cigna, her health insurer, said it would waive out-of-pocket costs for “telehealth” patients seeking coronavirus screening through video conferences. So Taylor, a sales manager, talked with her physician on an internet video call.
The doctor’s office charged her $70. She protested. But “they said, ‘No, it goes toward your deductible and you’ve got to pay the whole $70,’” she said.
Don't Miss A Story
Subscribe to KHN’s free Weekly Edition newsletter.
Policymakers and insurers across the country say they are eliminating copayments, deductibles and other barriers to telemedicine for patients confined at home who need a doctor for any reason.
“We are encouraging people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate copays, typically collected at the time of a doctor visit, for telehealth visits.
But in a fragmented health system — which encompasses dozens of insurers, 50 state regulators and thousands of independent doctor practices ― the shift to cost-free telemedicine for patients is going far less smoothly than the speeches and press releases suggest. In some cases, doctors are billing for telephone calls that used to be free.
Patients say doctors and insurers are charging them upfront for video appointments and phone calls, not just copays but sometimes the entire cost of the visit, even if it’s covered by insurance.
Despite what politicians have promised, insurers said they were not able to immediately eliminate telehealth copays for millions of members who carry their cards but receive coverage through self-insured employers. Executives at telehealth organizations say insurers have been slow to update their software and policies.
“A lot of the insurers who said that they’re not going to charge copayments for telemedicine ― they haven’t implemented that,” said George Favvas, CEO of Circle Medical, a San Francisco company that delivers family medicine and other primary care via livestream. “That’s starting to hit us right now.”
One problem is that insurers have waived copays and other telehealth cost sharing for in-network doctors only. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers promoting telehealth have little power to change telemedicine benefits for self-insured employers whose claims they process.
Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for seniors or by Medicaid for low-income families. All four insurance giants say improved telehealth benefits don’t necessarily apply to such coverage. Nor can governors or state insurance regulators force those plans, which are regulated federally, to upgrade telehealth coverage.
“Many employer plans are eliminating cost sharing” now that federal regulators have eased the rules for certain kinds of plans to improve telehealth benefits, said Brian Marcotte, CEO of the Business Group on Health, a coalition of very large, mostly self-insured employers.
For many doctors, business and billings have plunged because of the coronavirus shutdown. New rules notwithstanding, many practices may be eager to collect telehealth revenue immediately from patients rather than wait for insurance companies to pay, said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.
“A lot of providers may not have agreements in place with the plans that they work with to deliver services via telemedicine,” she said. “So these providers are protecting themselves upfront by either asking for full payment or by getting the copayment.”
David DeKeyser, a marketing strategist in Brooklyn, New York, sought a physician’s advice via video after coming in contact with someone who attended an event where coronavirus was detected. The office charged the whole visit — $280, not just the copay ― to his debit card without notifying him.
“It happened to be payday for me,” he said. A week earlier and the charge could have caused a bank overdraft, he said. An email exchange got the bill reversed, he said.
With wider acceptance, telehealth calls have suddenly become an important and lucrative potential source of physician revenue. Medicare and some commercial insurers have said they will pay the same rate for video calls as for office visits.
Some doctors are charging for phone calls once considered an incidental and non-billable part of a previous office visit. Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina are paying for phoned-in patient visits, according to America’s Health Insurance Plans, a lobbying group.
“A lot of carriers wouldn’t reimburse telephonic encounters” in the past, Corlette said.
Catherine Parisian, a professor in North Carolina, said what seemed like a routine follow-up call with her specialist last month became a telehealth consultation with an $80 copay.
“What would have been treated as a phone call, they now bill as telemedicine,” she said. “The physician would not call me without billing me.” She protested the charge and said she has not been billed yet.
By many accounts, the number of doctor encounters via video has soared since the Department of Health and Human Services said in mid-March that it would take “unprecedented steps to expand Americans’ access to telehealth services.”
Medicare expanded benefits to pay for most telemedicine nationwide instead of just for patients in rural areas and other limited circumstances, HHS said. The program has also temporarily dropped a ban on doctors waiving copays and other patient cost sharing. Such waivers might have been considered violations of federal anti-kickback laws.
At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows private, high-deductible health insurance to make an exception for telehealth in patient cost sharing. Such plans can now pay for video doctor visits even if patients haven’t met the deductible.
Dozens of private health insurers listed by AHIP say they have eliminated copays and other cost sharing for telemedicine. Cigna, however, has waived out-of-pocket costs only for telehealth associated with COVID-19 screening. Cigna did not respond to requests for comment.
Teladoc Health, a large, publicly traded telemedicine company, said its volume has doubled to 20,000 medical visits a day since early March. Its stock price has nearly doubled, too, since Jan. 1.
With such a sharp increase, it’s not surprising that insurers and physicians are struggling to keep up, said Circle Medical CEO Favvas.
“It’s going to be an imperfect process for a while,” he said. “It’s understandable given that things are moving so quickly.”
Abbie VanSickle, a California journalist, wanted her baby’s scheduled wellness visit done remotely because she worried about visiting a medical office during a pandemic. Her insurer, UnitedHealthcare, would not pay for it, the pediatrician told her. Mom and baby had to come in.
“It seems like such an unnecessary risk to take,” VanSickle said. “If we can’t do wellness visits, we’re surely not alone.”
A UnitedHealthcare spokesperson said that there was a misunderstanding and that the baby’s remote visit would be covered without a copay.
Jacklyn Grace Lacey, a New York City medical anthropologist, had a similar problem. She had to renew a prescription a few weeks after Cuomo ordered insurers to waive patient cost sharing for telehealth appointments.
The doctor’s office told her she needed to come in for a visit or book a telemedicine appointment. The video visit came with an “administrative fee” of $50 that she would have had to pay upfront, she said — five times what the copay would have been for an in-person session.
“I was not going to go into a doctor’s office and potentially expose people just to get a refill on my monthly medication,” she said.
We’ve made changes to help lessen the chances you’ll come into contact with COVID-19.
Already scheduled an appointment? Visit the appointment waiting room.
Urgent COVID-19 and flu problems
Open Monday through Friday, 7:30 a.m. to 7:30 p.m. and Saturday and Sunday, 8 a.m. to 5 p.m.
- Marysville**
- Shoreline*
- Smokey Point*
- Book a virtual visit. Call 1-425-257-1400.
These sites will ONLY see flu or COVID-19 symptoms.
For problems that are not COVID-19 or flu
Open Monday through Friday, 7:30 a.m. to 7:30 p.m., and Saturday and Sunday, 8 a.m. to 5 p.m.
- Marysville**
- Mill Creek
- Shoreline*
- Smokey Point**
- Snohomish
Kaiser Permanente Emergency Copay
These sites will NOT see flu or COVID-19 symptoms.
*Kaiser Medicare Advantage HMO and Commercial HMO are out of network in King County.
**Kaiser Core and Medicare Advantage HMO are out of network at Marysville and Smokey Point.
Walk-in clinic or ER, what's the difference?
- Abdominal pain
- Allergies
- Asthma
- Colds
- Cough or upper respiratory symptoms
- Ear or sinus pain
- Fevers
- Flu symptoms
- Foreign object in nose
- Headaches
- Minor burns and bruises
- Possible broken bones
- Rash or hives
- Scrapes and cuts
- Sprains
- Stings and bites
- Urinary symptoms
- Work-related injuries
Call 911 and seek emergency care for sudden or unexpected medical problems, like:
- Amputation of limbs or deep wounds with severe bleeding
- Chest pain (suspected heart attack or stroke)
- Inhaled smoke or chemical
- Major burns to the face or large areas of the body
- Physical or sexual assault
- Poisoning, overdoses and suicidal behavior
- Pregnancy problems over 20 weeks, including labor, bleeding, fluid leaks or the fetus has stopped moving
- Severe head injuries with loss of consciousness or new seizures
- Sudden confusion, weakness, dizziness, numbness, severe headache or difficulty speaking or breathing
- Vomiting blood
Walk-in clinic FAQs
Kaiser Copay Waiver
It depends, and we’ll do our best to help you quickly. Typical waits are 15 minutes to an hour. Often, our walk-in clinics can see you faster than an emergency room. Schedule your spot or check the wait times before you go.
You’ll see one of our experts: a medical doctor, a nurse practitioner, a physician assistant or a doctor of osteopathic medicine. They have a great deal of skill and knowledge. Each one is devoted to making lives better through health and healing and doing what is right for each patient.
Check with your health plan for details and copay amounts. We bill urgent care visits as an office visit, not ER care. Walk-in clinic care tends to cost patients less than an ER visit.
Use our price sheet to view current prices for primary care and walk-in clinic services. This includes physician visits, preventive visits, preventive screenings and other services.
If you’re in severe pain, call 911. If you’re not, the walk-in-clinic might be faster, more helpful and less costly. Your health information from the visit can be shared with your primary care doctor and any specialists as needed.
No, you can seek urgent care in our walk-in clinics, even if you don’t have a primary care provider (PCP). If you don’t have a PCP, we think it’s important to find one. We are happy to help you do so. You want a doctor who knows you and your unique health care needs. Everyone is different. For the best health, find yourself a PCP for annual visits.
Walk-in clinic visits are billed as office visits, not as ER or urgent care center visits. Please check with your health plan to find out how walk-in visits are covered.
COVID-19 FAQs
Kaiser Hospital Copay
- Congestion or runny nose
- Cough
- Diarrhea
- Fatigue
- Fever or chills
- Headache
- Muscle or body aches
- Nausea or vomiting
- New loss of taste or smell
- Shortness of breath or difficulty breathing
- Sore throat
If you have a higher chance of becoming very sick with COVID-19, you may want to stay home and book a virtual walk-in clinic visit instead. Can you answer “yes” to any of these?
- Age 65 or older?
- Severely overweight?
- Have diabetes (whether you use insulin or not)?
- Have asthma (moderate or severe)?
- Have COPD, emphysema or other serious lung problem?
- Have a serious heart problem?
- Have kidney disease with dialysis?
- Have liver disease?
- Live in a nursing home or long-term care facility?
- Have problems with your immune system?
If you answered “yes,” think about booking a virtual visit. To book a virtual visit, call 1-425-257-1400.