Breakthrough is making it easy for you to see a variety of patients via video counseling. We know it might be a bit confusing, so we want to take a moment to help you understand the three types of patients you can see:

  1. Self pay patients
  2. Patients insured by an insurance company not contracted with Breakthrough
  3. Patients insured by a Breakthrough contracted insurance company


Self pay patients

Any patient who wishes to pay out-of-pocket can do so, whether the patient finds you via the website or a face-to-face (F2F) client who would like to use video counseling either exclusively or as an adjunct to F2F care. Self pay patients may schedule an appointment with you via the Breakthrough site. If you elect to bill the patient directly for your services, check the "I'll bill the client myself" box. Note: Even if you decide to bill the client directly, they will still be required to enter their credit card information.

If you haven’t already done so, please list your self pay rate on your Profile so prospective patients have this information prior to contacting you. To include a self pay rate:

  1. Log into your Breakthrough account
  2. Click your name and then select “Edit Profile”
  3. Enter your rate in the “Self pay rate” field

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Patients insured by an insurance company not contracted with Breakthrough

If you have a patient who is interested in and would benefit from video counseling, has behavioral health benefits through an insurance company not currently contracted with Breakthrough, please use the following procedure to verify if a video counseling session is reimbursable:

  1. Contact the patient’s insurance company at the “Member Services” or “Customer Service” telephone number, which is located on the reverse side of the patient’s identification card.
  2. State, “I have a patient who I believe would benefit clinically from video counseling and I am a part of Breakthrough, a network of providers that offers HIPAA-compliant video counseling. If I see my patient via Breakthough’s video counseling platform, will the session be reimbursed?”

If the insurance company’s representative states that the session will be reimbursed:

  1. Direct the patient to www.breakthrough.com to register as a self pay patient and schedule an appointment with you.
  2. Remember a credit card is required from the patient, although you do not have to use it for collection of the co-pay, co-insurance, deductible, or for other amounts, which are the responsibility of the patient.
  3. When the session has concluded, complete the Post Session Report, indicating whether you would like Breakthrough to bill the patient’s credit card. State in the “Notes” field the insurance company, group name and plan ID you will bill for your services. checkbox_screenshot
  4. You are responsible for filing the claim, using the GT modifier.

If the insurance company indicates that they will not reimburse you for telehealth services, inquire how you can appeal the decision and secure a written coverage determination.


Patients insured by a Breakthrough contracted insurance company

Any patient who is insured by a Breakthrough contracted payer is eligible for telehealth via Breakthrough and you will be reimbursed. When you complete the Post Session Report, the GT modifier will be automatically included to indicate that the session occurred via telehealth.

List of Breakthrough contracted payers by location:

California:
  • Blue Shield of CA – Magellan/HAI-CA
  • Western Health Advantage
District of Columbia (D.C.):
  • CareFirst BlueChoice HMO
Maryland:
  • CareFirst BlueChoice HMO
Texas:
  • Aetna
Virginia:
  • CareFirst BlueChoice HMO
If you and the patient agree to do so, you may direct Breakthrough to bill the patient’s credit card for co-pay, co-insurance, the deductible, or for other amounts, which are the responsibility of the patient.

Although your contract with Breakthough includes a nominal fee for use of the telehealth system for self pay patients, we are waiving the fee at this time. In the future, if we determine that it is necessary to charge the fee, we will notify you well in advance. We are actively working to expand the list of insurance companies contracted with Breakthrough that reimburse for telehealth.


We hope you now have a clear understanding of the types of patients you can see using Breakthrough. Our goal is to ensure that Breakthrough offers a phenomenal experience for you and all your patients. As always, if anything requires clarification, we hope you will call us at 888-282-2522 or email us at network@breakthrough.com.


Sincerely,

The Breakthrough Network Team