More and more Americans are utilizing the new "telehealth" services that are now more widely available after the pandemic forced everyone to adjust to social isolation limits. The term "telehealth" describes medical services such as physical examinations and behavioral therapy that are provided remotely, typically over the phone or online. This treatment is especially beneficial for individuals who are at high risk for infection.
Some major insurance companies have expanded coverage for these services in order to handle the rise in demand for "socially-distanced" care during the COVID-19 pandemic. However, many of these businesses are discontinuing this coverage as of October 1, 2021, due to the greater distribution of vaccines and laser safety regulations.
Your ability to use telehealth services, however, is reliant on your medical professionals and the details of your insurance plan.
State Laws that Require Insurance Companies to Provide Telemedicine
Currently, 26 states have rules requiring private insurers to pay medical practitioners for services rendered via telemedicine. These laws are frequently known as "Parity" laws. Ten more states are also thinking about passing similar legislation. While every regulation is different, they all typically state that private payers cannot consider the patient's location when determining whether to pay for a video visit, allowing for covered patients to be present at home or at the office throughout the consultation. The American Telemedicine Association's brochure is a fantastic resource for finding out more about the rules in your state.
Several states with parity legislation have exempted specific insurance plan types. Small group insurance plans and worker's compensation policies may be able to choose not to fund telemedicine.
Providers and Technologies CoveredReal-time video visits are recognised as an appropriate kind of telemedicine in any state with a parity statute. Some also include services offered through store-and-forward telehealth or secure email. Most of the time, any provider who is qualified to bill an insurance company for an in-person visit is also qualified to bill an insurance company for a remote visit, although this is not always the case. Before the physician can bill for a video visit, some states need that a patient relationship be formed through an in-person visit, while many states do not have this requirement.
Payment RegulationsSome state regulations mandate that insurers pay the same amount for telemedicine video visits as they do for in-person encounters, while others give the insurer complete discretion over how much to pay the clinician. The good news is that many insurers understand the usefulness of telemedicine and have chosen to cover video visits on their own even in jurisdictions that do not require it. This is true even in states without these parity legislation. Therefore, it is still a good idea to check with your insurance carrier to see if your appointment is covered, even if your state does not have a statute regarding telemedicine.
Medicare Telehealth Reimbursement
Medicare has a purposefully constrained approach to telemedicine coverage. Its objective is to provide patients in isolated and rural locations with access to specialists who might not be readily available there. Patients must therefore reside in a region classified as a Health Professional Shortage Area that is outside of a metropolis.
Medicare additionally mandates that patients visit a predetermined healthcare institution in order to start a video visit. From then, telehealth technology can be used by the patient and their local healthcare professional to connect to a distant specialist. Medicare does not provide coverage for video visits made from a "specified originating place" other than the patient's home or another location.
Every state Medicaid programme, though they vary, provides some kind of coverage for telemedicine. While some, like Medicare, require patients to be present at a healthcare facility during the visit, others permit visits from homes or places of employment. You may find out more about how Medicaid handles telehealth in your state by reading the Center for Concerned Health Policy's thorough analysis of all 50 states and the District of Columbia.
The current complexity of telemedicine coverage is problematic. But laws and policies will swiftly alter to welcome telehealth as more insurance companies and state legislatures recognise the advantages of telemedicine in their regions.