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Private Insurers Expand Telehealth Coverage

Which plans pay what — and how new state rules factor in

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Over the past year, there's been an astounding 5,680 percent growth in telemedicine claims to private insurers, according to FAIR Health, a national, independent nonprofit group.

The FAIR Health National Private Insurance Claims database, the nation's largest repository of private health insurance claims, shows that in March and April, private national spending on telemedicine services was nearly $4 billion, compared to less than $60 million for those two months in 2019.

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"This is the wave of the future,” says Christopher Regal, director of clinical innovation at America's Health Insurance Plans, who notes that while the current spikes in usage may come down, telehealth is likely to be incorporated more broadly going forward and that telemedicine “is reducing no-show rates at appointments due to convenience."

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Specific coverage, copays and cost sharing

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Many commercial insurers have increased the number of the services they cover — some temporarily and others on a permanent basis. For instance, BlueCross BlueShield of Tennessee recently announced that it will cover virtual visits with in-network providers permanently. The insurer will pay for phone and video visits with primary care providers, specialists, behavioral health providers, and occupational, physical and speech therapists. 

Other insurers have temporarily waived cost sharing — including copays, deductibles and coinsurance — for all virtual visits. They include Highmark, Aetna, Cigna, EmblemHealth, Humana, Anthem, AllWays Health Partners and AvMed. In many cases, cost sharing is waived only if you use an in-network provider.

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Other insurers, such as UnitedHealthcare, are waiving cost sharing only for virtual visits related to COVID-19 care. In some cases, a telemedicine visit is free as long as you see one of the insurer's virtual providers, who may be affiliated with a third-party telemedicine platform. Florida Blue, which is partnering with Teladoc, a telemedicine company, is offering free virtual visits for Medicare Advantage members. For some of those with other insurance coverage, the company will waive the virtual care copay if a Teladoc provider is used.

While many of the cost-sharing waivers are temporary (some expire as early as Sept. 30), telemedicine doesn't appear to be going away anytime soon. “Telemedicine will be here because we still need it,” says Kwong, “There will likely be some scaling back in terms of insurance coverage, but some states are making their policy changes permanent.”

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New state mandates expand coverage

In many cases, the extent of your insurance coverage will hinge on where you live. During the pandemic, 47 states modified their requirements for telemedicine, which encouraged doctors and patients to use it, according to the Federation of State Medical Boards. For instance, many states are allowing doctors to treat new patients via telemedicine and issue prescriptions for patients they’ve never examined. In addition, doctors can provide telemedicine services to patients in states in which they’re not licensed to practice.

In addition, many state governors issued mandates that required private insurers to increase access to telemedicine, according to an analysis by the Kaiser Family Foundation:

  • Six states expanded their coverage of telemedicine for a broad range of services, and six states expanded coverage for a limited number of services. For instance, Connecticut allowed additional providers to deliver care via telemedicine. They include dentists, genetic counselors and occupational and physical therapy assistants. 
  • In Arizona, the governor issued an executive order requiring health insurers to expand telemedicine coverage for all services that would normally be covered for an in-person visit until the public health emergency ends. 
  • In Rhode Island, health insurers must cover telemedicine visits for primary care, specialty care and behavioral health care.
  • Fifteen states are waiving or limiting cost sharing for telemedicine services. Seven states are waiving cost sharing for COVID-19-related care, and eight states are waiving or limiting cost sharing for all services. In some cases, cost sharing is waived only for services provided by in-network providers. 
  • In New Hampshire, all insurers must cover medically necessary COVID-19-related treatment via telemedicine without requiring any copays, deductibles or coinsurance. In New York, insurance companies are required to waive copays for telemedicine visits related to COVID-19.
  • Seventeen states — including Montana, New Hampshire and Washington — require insurers to reimburse doctors for telemedicine services at the same rate as in-person care. In Massachusetts, the governor ordered that all commercial insurers, self-insured plans and state health plans cover all clinically appropriate telemedicine services at the same rate as in-person care.
  • Thirty-five states require expanded options for the delivery of telemedicine services, such as phone visits. Blue Cross Blue Shield of North Carolina — the largest insurer in the state — is covering phone and video visits at the same rate as in-person visits.

Many of these mandates will expire at the end of the public health emergency, but several states recently made them permanent:

  • In June, the governor of Idaho signed an executive order making permanent more than 150 rules related to telemedicine services. Among them: out-of-state providers can provide telemedicine services to Idaho residents.
  • In July, New Hampshire made several telemedicine mandates permanent, including a requirement that private payers reimburse for telemedicine services on par with reimbursement for in-person services. The state also permanently expanded the types of providers who can deliver telemedicine to include physician assistants, psychologists and dentists, among others.
  • In Ohio, home health and hospice aides, certain types of nurses in home health or hospice settings, dentists and behavioral health practitioners can use telemedicine on a permanent basis. 
  • In Colorado, insurers are prohibited from imposing a different maximum amount for telemedicine services; imposing limitations on audio or video technologies; imposing additional certification, location and training requirements as a condition for reimbursement; and requiring a patient to have an established relationship with a provider.

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