Flu coverage will include new vaccine after July 1

We will cover a newly available flu vaccine, CPT code 90682, for any dates of service on or after July 1, 2017. We will cover this vaccine for both our commercial and Medicare plans.

For most ConnectiCare members, there is no copayment, coinsurance or deductible if the only reason for a visit is to get a flu shot. If there is an additional, separate reason billed for a visit, copayments, coinsurance and/or deductibles will apply.

If a member receives a flu vaccination from a non-participating provider, we will cover the usual-and-customary amount.

If a commercial member pays for the immunization out of pocket, he or she can provide a receipt to ConnectiCare along with a completed Out-of-Plan Reimbursement Form. Medicare members should use this Medicare Out-of-Plan Reimbursement Form.

Our up-to-date telemedicine policy

Here's ConnectiCare's policy on the use of communication technologies to diagnose and treat patients.

Medicare news: Treatment of dual-eligible patients

Something to keep in mind: patients who are eligible for both Medicare and Medicaid and designated as Qualified Medicare Beneficiaries (QMBs) cannot be billed for any Medicare cost-share, including deductibles, coinsurance and copayments. Federal law prohibits balance billing of these patients.

This applies to all Medicare providers regardless of whether they accept Medicaid.

The QMB program is a Medicaid program that exempts Medicare beneficiaries from having to pay their Medicare cost-share. If providers want to get paid for the patient's cost-share, the bill of service may be submitted to Medicaid for reimbursement.

For more information, please go to this Medicare Learning Network resource.

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