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Published On: Thu, Mar 21st, 2019

Insurance and Telemedicine: What Is Being Covered, And By Whom?

What Is Telemedicine?

In the healthcare industry, the term telemedicine is used to explain the remote diagnosis and treatment of patients via channels like the web, and mobile devices.

It allows patients to interact with physicians and medical professionals from anywhere, provided that internet access is available.

The term, alongside telehealth, can also be used to explain other specialized methods of remote diagnosis and treatment, like wearable devices.

photo supplied, courtesy of guest blogging network

Originally created to serve patients in remote locations and help make healthcare more accessible, telemedicine has become increasingly common in mainstream healthcare over the course of the last decade.

This can be contributed, in part, due to the fact that we are living in a far more mobile society than we used to.

In fact, Digital Authority Partners reports that 77 percent of the U.S own a smartphone, with global mobile phone usage predicted to pass the five billion mark by the end of 2019.

With this increased rate of mobile usage, American’s have become a lot more mobile, and the demand for healthcare that meets their needs has, inevitably, increased.

This means that more people than ever are turning towards telemedicine solutions to provide them with healthcare when they need it, from wherever they are. Even renown healthcare personalities have started warming up to the benefits of telemedicine services. Simon Stertzer, the first doctor to perform an angioplasty in the US, has recently talked about the benefits of telemedicine on the EHealth Radio Network. This shows that there is an increasing demand and interest for telemedicine services, both from a consumer and a physician point of view.  

Some people, however, are held back from accessing these services as they aren’t sure what is covered, and by whom.

If this is you, we’re here to put your mind at rest by going in detail about what is and isn’t covered and who covers it, so you can see if you’re eligible in a few simple minutes.

Who Is Covering It?

State Laws

One of the biggest indications we have that telemedicine has been embraced by the mainstream medical community is that there are now laws in several states that force private insurers to reimburse healthcare providers for services that are delivered through telemedicine.

As of March 2019, 38 states have created these laws, often referred to as parity laws, alongside Washington DC.

Generally, these legislations set out that private payers cannot take the patient’s location into account when the decision to cover a video visit comes into play.

Effectively, this means that they must cover the encounter regardless of whether it takes place from within a doctor’s office, a patient’s home, or their place of work.

The laws do differ slightly depending on the state you are in, so it’s worth checking out the American Telemedicine Association to find out the specifics in the state you live in.

It is also worth noting that many states with parity laws do not cover everything, and make exceptions for certain type of insurance plans.

If you have a worker’s compensation plan or a small group plan, it’s worth checking your eligibility, as these insurers may be eligible to opt out of telemedicine coverage for their clients.

Medicare

Although Medicare does offer telemedicine coverage in certain circumstances, they do have a number of limitations that aren’t experienced in states with parity laws.

Generally, remote radiology, pathology and some cardiology telemedicine services will be covered under the title of a physician services.

If you live in a rural area, Medicare will also cover video visits to beneficiaries.

These visits must, however, be conducted at a specific originating site. In other words, you must be at the location of an eligible Medicare beneficiary at the time the treatment or diagnosis begins.

Medicaid

Medicaid is the furthest behind when it comes to adapting to telemedicine in the medical field, but most plans will cover some kind of telehealth services.

It’s important that you look up the legislation for your specific plan, however, as each one will have a different set of rules and requirements you must look out for.

What Is Covered?

The specifics of what is covered under your insurance will generally depend on the state you live, and the type of plan you have.

If you live in a state with a parity law, however, you are guaranteed to be able to claim real-time video visits as an acceptable form of telemedicine.

Some states and insurance plan will also cover services that are provided by secure email, or store-and-forward telemedicine technology.

With insurance plans like Medicare and Medicaid, some telemedicine services including remote audiology, pathology, and some cardiology are also covered.

To put it more simply, it’s often the case that providers who can bill an insurance company for an in-person visit can do the same for a more remote one.

There are situations where this isn’t viable, such as where someone isn’t living in a parity state and hasn’t got a sufficient Medicaid plan, however, so it’s always worth checking with your specific state and insurance plan beforehand.

In some states, it’s required that patient relationships must be established with a face to face visit before a provider can bill for a visit.

If this isn’t the case, in many states like California, then telemedicine can take place via an online connection straight away.

To find out more, it’s worth checking out your specific state and insurance laws using the American Telemedicine Association link we provided above.

As a general rule, some of the more mainstream telemedicine formats, like virtual reality technology and wearable devices are not covered under insurance or parity laws.

Summary

As you can see from this article, knowing what telemedicine services are and aren’t covered by insurance isn’t always a straightforward process.

Not only does the legislation in place for the 38 parity states have exceptions with loopholes that make the process more confusing, but specific insurances are able to set their own rules, too.

With that being said, we hope we have made things a little more clearer for you going forwards.

Generally, more popular telemedicine services, like video conferencing calls, are covered by most insurance policies—even those in non-parity states.

Things may get a little more selective when the services become more specialised, but this is not to say that you definitely won’t be covered.

As mentioned before, we recommend that you check your state laws and specific insurance policy to find out exactly what is and isn’t covered so you aren’t left with any unexpected discoveries after the telemedicine technology has already been accessed.

Author: Codrin Arsene, CEO @ Digital Authority Partners, a healthcare marketing agency out of Chicago, Illinois.

About the Author

- Outside contributors to the Dispatch are always welcome to offer their unique voices, contradictory opinions or presentation of information not included on the site.

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