You should check with your insurer regarding how telemedicine is covered under your particular policy, but here’s a general look at the coverage landscape.
Right now, twenty-six states have laws that require private insurers to reimburse healthcare providers for services delivered through telemedicine. These are often referred to as “Parity” laws. In addition, ten more states are also considering legislation to do the same. Each law is different, but they generally say that private payers can’t take the patient’s location into account when deciding to cover a video visit, making it possible for covered patients to be at home or work during the encounter. This guide by the American Telemedicine Association is a great way to learn more about the laws of your state.
Many states with parity laws have made exceptions for certain types of insurance plans. Worker’s compensation plans and small group plans may be eligible to opt out of coverage for telemedicine.
Every state with a parity law includes real-time video visits as an acceptable form of telemedicine. Some also cover services provided by secure email, or store-and-forward telehealth. In most cases, any provider who can bill an insurance company for an in-person visit is eligible to be paid for a remote one, but this is not always the case. Some states require that a patient relationship be established with an in-person visit before the provider can bill for a video visit, but many states do not have this requirement.
Some state laws require that insurers pay the same amount for video visits done via telemedicine as they do for an in-person encounter, while others leave the decision about how much the provider will be paid up to the insurer. The good news is that even in states without these parity laws, many insurers recognize the value of telemedicine and have decided to cover video visits on their own even in states that do not require it. So even if your state does not have a law regarding telemedicine, it is still a good idea to check with your insurance company to see if your appointment is covered.
Medicare has a telemedicine coverage approach that is intentionally limited in scope. Its goal is to make sure that patients in remote and rural areas have access to a specialist that may not be available near by. Therefore, patients must live in what is known as a Health Professional Shortage Area that is outside a metropolitan area.
In addition, Medicare also requires that patients go to a designated healthcare facility in order to initiate a video visit. From there, the patient and their local provider can connect to a distant specialist using telehealth technology. Video visits from home, or anywhere that is not what’s called a designated “Originating site,” are not covered under Medicare.
Every state Medicaid program offers some type of coverage for telemedicine, but they are all different. Some are like Medicare and require patients to be at a healthcare facility during the visit, while others allow for visits from home or work. The Center for Concerned Health Policy has a comprehensive scan of the 50 states and District of Columbia that will help you learn more about how Medicaid approaches telehealth in your state.
It is unfortunate that telemedicine coverage is so complex right now. But as more and more insurance companies and state legislatures see the benefits of telemedicine on their communities, laws and policies will change quickly to embrace telehealth.