Is Telehealth Still Covered by Insurance? Your Patients Are About to Find Out

Telehealth has exploded over the course of the coronavirus pandemic, but the rise of virtual care may soon be short-lived. Health systems have been hemorrhaging money over the last six months and scaling back telehealth usage could help some companies recoup their finances.

Several major insurance providers, including UnitedHealthcare and Aetna Blue Cross Blue Shield, recently altered their telehealth reimbursement rates, which could lead to additional costs and surprise bills. If your patients use telehealth, find out what this means for you.

Telehealth Goes Big

Virtual care had been on the rise for years, but it accelerated exponentially during the pandemic. Talking to patients over live video and audio is much safer than meeting in person. It also allows high-risk individuals with pre-existing conditions, such as asthma, diabetes, and hypertension, to stay at home while checking in with doctors and specialists remotely.

To promote the use of telehealth, Congress passed The Coronavirus Aid, Relief and Economic Security Act, or CARES Act, on March 27th, 2020, which removed barriers to accessing these services. The Centers for Medicare & Medicaid then sent a toolkit to state Medicaid agencies encouraging them to adopt policy changes that promoted the expansion of telehealth.

In many cases, this meant providers would be reimbursed at the same rate for telehealth visits as they would if they rendered the same services in-person. Throughout the pandemic, 80 new telehealth services were being reimbursed at the same rate as in-person services under Medicare. The private insurance industry quickly followed suit by mimicking these policies.

Over the next six months, telehealth usage skyrocketed.

Reports show that telehealth visits went from 13,000 a week at the start of the pandemic to 1.7 million per week by July among Medicare recipients. Between mid-March and mid-June 2020, during the height of the national lockdown, over 9 million telehealth visits were conducted for Medicare recipients.

Meanwhile, private insurers reported a 4,000% jump in the number of telehealth claims compared to the previous year.

Removing Telehealth Protections

This all may sound great for patients and providers, but not for the insurance companies, which have lost revenue since the start of the pandemic. These protections for telehealth were always meant to be temporary, and now, telehealth’s reign may soon be coming to an end.  

There was always a fear among insurance companies that telehealth would lead to a surge in demand for healthcare services. If people can visit their doctor online, they would access these services more often than they would if they had to make the trip in person. This would eventually eat into the insurance companies’ profits, even if it means people are taking better care of their health.

Even as the pandemic rages on, several insurance companies have started limiting protections for telehealth. UnitedHealthcare is getting rid of policies that waive co-pays and other fees for non-COVID-related appointments. Meanwhile, Anthem Blue Cross Blue Shield says it will cover telehealth services through the end of the year, but this only applies to the first two appointments. Medicare and Medicaid are expected to cover telehealth through the end of the year, but it’s not clear what will happen on January 1st, 2021.

Rescinding these protections means that doctors and specialists won’t get reimbursed at the same rate for telehealth services as they would for in-person appointments, which will limit access to telehealth across the country.

According to estimates from the American Hospital Association, the country’s health-care systems are losing an average of $50.7 billion per month. Short on cash, doctors and hospitals need these protections to see patients remotely. Otherwise, they won’t get money from the insurance company. But if telehealth is no longer an option, many patients will still likely stay away from the doctor’s office if it means risking exposure to the coronavirus virus.

Further complicating the situation, Medicare and Medicaid plans vary from state to state. A number services will no longer be covered in certain parts of the country. This means some patients will likely encounter a surprise bill or delay accessing care due to the cost.

Ultimately, we will be left with a hodgepodge of telehealth coverage across the country as these protections fall by the wayside. Yet, telehealth remains vital to our country’s response to the pandemic, especially as we head further into fall, winter, and flu season. Patients need to be able to see their doctor online if they have a sore throat, cough, or trouble breathing. Many people won’t know whether their symptoms are related to COVID-19 or just a case of the common cold.

Be on the lookout for changes to telehealth coverage as insurance companies revise their policies. Telehealth may be the future of healthcare, but only if it continues to make a profit.