Go To Top
See how much YOU can save
See how much YOU can save
Valid Zipcode Required
Invalid Carrier
Check this box if you have multiple vehicles in your family.

Want to bundle home and auto insurance for potential discounts?

Does health insurance cover telehealth?

By Posted :

Telehealth, also called telemedicine, lets you see a doctor or other health care provider without visiting an office or hospital. Instead, providers can evaluate, diagnose or consult with you remotely using videoconferencing, phone, an app or another secure electronic means. 

The COVID-19 pandemic has made telehealth more common and remote doctor visits are likely only to increase in the coming years. However, your insurer may currently limit your telehealth benefits.

Let’s take a look at how telehealth works, state laws and restrictions, whether your health insurance allows telehealth and your options if an insurer denies your telehealth claim. 

 

What is telehealth?

Telehealth refers to services that provide care using telecommunications or similar technologies.

"It broadly covers all health services, including non-clinical and mental health services, conducted using videoconference, over the phone, with an app or employing other secure applications," says Anne Brunson, vice president of service operations at Maestro Health.

The Centers for Disease Control and Prevention says telehealth can also involve being examined by a nurse or medical assistant at a medical facility while the consulting doctor provides a remote evaluation electronically. Additionally, it encompasses remote patient monitoring, whereby your health is measured and monitored remotely in real-time or via recordings and documents.

Telehealth allows you to get care without leaving the house. You can connect safely, quickly and economically.

"Not only does telehealth protect you and the people around you, but it also protects health care workers on the front line of this pandemic," explains Steven Richardson, vice president of population health and a board-certified physician assistant with Unite Health Share Ministries. "Additionally, telehealth provides more access to care. That's because telehealth operating days are typically seven days a week and hours stay open longer than the average doctor's office or urgent care facility."

Here are examples of telehealth services: 

  • Checkups with providers. 
  • Screenings for conditions like COVID-19.
  • Therapy sessions with mental health specialists. 
  • Support and coaching for chronic health conditions like nutrition counseling and weight management.
  • Providing care for people in rural areas who aren’t near health care facilities. 
  • Post-hospitalization follow-ups.
  • Non-emergency care for long-term care facility residents.

The use of telehealth is growing. Over three in four U.S. hospitals now connect remotely with patients using video, audio, email, chat and other technologies.

 

State laws about telehealth

Telehealth state laws can be complicated and inconsistent around the country. All 50 states have some form of health insurance reimbursement for live video. However, only 21 states have reimbursement for remote patient monitoring, says Amber Moss, director of Benefit Services for Iscential Inc.

"It's not as simple as requesting a virtual appointment with your doctor," she says. "Most states require physicians to be licensed to practice telehealth in the originating site's state, while others require the provider to have a valid license in the state where the patient is located."

So, even though you and your physician may want to schedule a telehealth session, it may not be allowed in your state or area.

Richardson adds that each state's medical board governs telehealth rules. The regulations shaping how a clinician performs telehealth vary widely.

"The medical boards also regulate the type of technology needed in the states. For instance, in Maine and Connecticut, you must see the patient via video as a simple audio phone call will not meet the minimum requirements for a telehealth visit," adds Richardson.

Tom Conroy, CEO/co-founder of MedSign, says some states have parity laws that require insurance companies to reimburse at the same rate as in-person care for services provided.

"However, this is not nationwide. For this to become a standard across the country, the government needs to sit down with the major insurance firms to work out an agreement for telehealth hardware and services as well as for payments to medical professionals," says Conroy.

The Federation of State Medical Board offers a thorough review of telehealth laws and restrictions by state.

 

Private health insurance and telehealth

Further complicating matters is that private health insurance providers have their own telehealth reimbursement rules. 

"The big five carriers -- Blue Cross Blue Shield, United Healthcare, Cigna, Aetna and Humana -- all offer some form of coverage for telehealth services. But options may vary based on specific plan selections, so it's important that you understand what's covered under your specific plan," suggests Moss.

Richardson notes that most preferred provider organization (PPO) plans allow telehealth visits. On the other hand, many health maintenance organization (HMO) plans commonly haven't adopted telehealth due to the payment structure with physicians as a capitated rate and not fee-for-service. In that case, the plan may contract with a telehealth company. So, you’d get telehealth services through the company rather than your doctor. 

As always, you need to verify if the provider is within your plan’s network and the costs associated with the visit. 

"Also, find out how to set up your telehealth services. Most insurance member portals will have instructions on how to do this. For example, there may be an app available for download and a verification process may be required," Moss says.

 

Medicare and telehealth

Original Medicare, which is Parts A and B, covers most telehealth appointments.

"Currently, Medicare patients may use telecommunication technology for office or hospital visits and other services that generally occur in-person. These include virtual check-ins with your practitioner using phone services or other devices and e-visits via an online patient portal," explains Moss.

Medicare provides a list of covered telehealth services. You can also see if a service is covered by searching by term.

"Note that with a telehealth visit, you'll have to cover the 20% co-payment, because Medicare looks at telehealth appointments as if they were regular appointments," says Jordan Shanbrom, an independent life insurance broker with California Life Coverage.

Also, Richardson cautions that Medicare telehealth protocols are rigid and not all Medicare providers offer telehealth services. 

That said, you may be eligible for more telehealth services if you have a Medicare Advantage plan. The Centers for Medicare and Medicaid Services allows Medicare Advantage insurers to offer expanded telehealth benefits. You need to check with the individual plan to see what telehealth is covered.

 

Medicaid and telehealth

Medicaid often provides access to telehealth services. However, state regulations vary. 

"States have made adjustments in key areas of telehealth in response to the pandemic, including expanding the Medicaid populations and technologies that can use telehealth," says Moss.

However, you may be restricted by whatever is the most economical for the provider.

"If it is more cost-efficient to see your doctor in person, Medicaid will not cover the telehealth appointment. Overall, there are restrictions on whether or not Medicaid will cover a given telehealth session based on efficiency, cost and availability," Shanbrom says.

The Centers for Medicare and Medicaid Services offers a telehealth toolkit. To confirm if Medicaid will cover your telehealth visit, check out the tool kit or call 800-335-8957.

 

What to do if your health insurance denies a telehealth claim

To avoid being declined, it's best to review your plan documents before scheduling or completing a telehealth appointment.

Shanbrom says you can appeal a claim denial with the insurer. 

"Typically, the insurance company will request that you prove that the telehealth services were covered or prove that it was necessary despite the cost,” Shanbrom says. 

Moss adds that each provider has a specific appeals process in the event of a claim denial. 

"Reach out to the carrier directly to understand the proper next steps to resolving any issues," advises Moss.

Alternatively, "seek out other insurance companies that provide the telehealth services, as there are many health insurance companies that provide telehealth," Conroy suggests.