The Scoop on Telehealth And Insurance Coverage
Gain expert insight into insurance coverage for telehealth services
The topic of insurance coverage for telehealth visits gets complex quickly. With the healthcare industry and insurance payer ecosystem still gaining their footing from the nonstop hits COVID-19 keeps bringing, there have been no final decisions on permanent coverage for virtual care visits. But, we do have a pulse on the current state of insurance coverage for telehealth, and insights from the experts on what the future will likely look like.
So, for right now let's stick to what we know. But don't fret! We will continue to update this blog as more information on the topic is released, so be sure to check back regularly.
Alright! Let's get into insurance coverage for telemedicine visits as it stands today.
Telehealth insurance coverage currently
Before we get into the specifics of what insurance will cover, it's important to familiarize yourself with the three types of telehealth most commonly used.
Synchronous: The most popular type of telemedicine and the one you typically think of when hearing the word 'telehealth' is synchronous telemedicine. It's a real-time visit with your clinician for a true back-and-forth conversation. The patient and the provider are communicating with each other as they would in a traditional office setting but it's over the phone, via chat, or through a video call.
Asynchronous: Asynchronous visits, sometimes referred to as store-and-forward, can be used for patient-doctor visits at times but is most often used for communication between providers. In these types of patient visits, communication between the two parties does not take place in real-time. There is a lag between submitting information, reviewing it and forming a diagnosis or treatment plan, then relaying updates and next steps back to the patient.
Remote Patient Monitoring (RPM): Remote patient monitoring allows a patient's care team to virtually monitor their condition from anywhere in the world, 24x7. The RPM device captures and sends data to the patient's care team in real-time so they can observe, report, and analyze their condition at all times.
Now that we covered the different methods of telehealth delivery, we can get into what you came here for - telehealth insurance coverage.
Commercial and private insurance coverage
Let's start off with commercial and private insurance.
Most commercial and private insurance carriers like Blue Cross Blue Shield, United Healthcare, and Aetna have broadened their coverage for telehealth services in response to coronavirus. In fact, some have even defined virtual care as an alternative to in-person visits which means they can be reimbursed the same as a traditional office appointment!
Right now, twenty-six states have implemented laws that require commercial and private insurance companies to reimburse providers for the services they delivered through telemedicine. And good news! Ten more states are considering implementing laws that do the same. Of course, it all depends on what state the patient lives in, so be sure to do your research.
Don't let those numbers scare you. Although some states are requiring insurers to reimburse, as of right now, all insurers, regardless of state, reimburse telehealth services in some capacity. So, to sum it up, most, if not all, commercial and private insurers are treating telemedicine visits as an alternative to a traditional, in-person visit. The best way to see what telehealth services are covered under insurance is to go straight to the source and ask!
Medicare and Medicaid coverage
Since Medicare and Medicaid are controlled and regulated by the government, it's a whole other telehealth reimbursement ballpark.
Medicare coverage
Medicare is a health insurance program run by the federal government. Individuals who can receive Medicare coverage include people aged 65 or older, people under the age of 65 with certain disabilities, and people of all ages with End-Stage Renal Disease.
Under Medicare coverage, most telehealth services are treated the same as in-person services. So, in other words, you will pay the same amount as if you received those services in a hospital or clinic setting. It's important to note that Medicare currently only covers synchronous telehealth visits so be sure to keep that in mind when scheduling your virtual care appointment.
Some services included under the Medicare coverage umbrella are:
Virtual office visits (think yearly checkups with your doctor online)
Psychotherapy (virtual appointments with a mental health provider)
Consultations
That's a relatively small list, so double-check if the care you are receiving is covered by Medicare before your telehealth appointment.
**COVID-19 Note: With the United States still in a state of public health emergency, some healthcare providers are reducing or completely waiving the amount paid for telehealth visits under Medicare. When making a telehealth appointment with a provider you do not know, be cautious and do your research to ensure they are not fraudulent.
Medicaid coverage
Unlike Medicare, Medicaid is administered and regulated by each state rather than at a federal level. It's the largest source of health coverage in the US covering over 72.5 million Americans including children, low-income Americans under age 65, pregnant women, parents, seniors, and individuals with disabilities.
Medicaid, generally, has widespread coverage across telemedicine services. Of course, it is regulated by state so it does vary.
Some quick facts about Medicaid coverage:
All states cover synchronous telehealth in some shape or form
Only 22 states cover asynchronous telehealth services
Remote patient monitoring is covered in 29 states
Those facts might be a little daunting, especially if you aren't in the states that cover those services. But, there is a silver lining. Each year, more states are changing their Medicaid telehealth coverage to include these services. In fact, just two years ago, only 21 states covered remote patient monitoring. States are constantly widening their coverage so patients can continue to have easy access to care. So, be sure to check out what your state's policies are on telehealth coverage.
Looking to the future
Things are looking up for telehealth services and insurance coverage! The pandemic lit a match under the virtual care fire and it's continuing to burn strong. With telehealth becoming a popular way for patients to receive care and providers to deliver it, insurance carriers are taking notice.
Experts in the healthcare industry are expecting most, if not all, insurers to make telehealth policies permanent that were put in place in response to the pandemic. In fact, some have already done so!
In looking to the future for telehealth, it's bright. Usage is growing and insurers are expected to grow their coverage to match that demand.
Powering an expansive payer coverage network
We hope this answered some of your questions and provided helpful resources with the latest updates to check out! All this talk about coverage of telehealth services has us thinking about OpenLoop. What is OpenLoop? We're glad you asked!
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Our suite of telehealth support services include:
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