Back to the Blog

Does Insurance Pay for Telehealth?

Posted: July 06, 2020

In recent months, providers around the globe have turned to telehealth as a safe and effective way to continue caring for patients during the global pandemic. While most patients appreciate the convenience and accessibility of telemedicine, it’s not uncommon for them to worry about insurance reimbursement.

Although many state legislations and private insurance companies appreciate the benefits of telehealth, not all offer coverage for telehealth services. Coverage depends on multiple factors including location, types of services provided, and payers. It’s important that patients learn all they can about their insurance company’s reimbursement policy prior to scheduling a telehealth appointment.

Telehealth Coverage Varies By State

As of today, there is no set standard regarding telehealth reimbursement. While some private insurance companies offer full coverage of telehealth visits, others have limitations or restrictions on what they allow. Occasionally, patients must receive prior approval from their insurance company before scheduling a telehealth appointment.

Fortunately, twenty-six states have laws in place to protect individuals that utilize telemedicine services. These parity laws require private insurance companies to cover telehealth appointments regardless of patient location. This makes it possible for patients to attend virtual visits from any location in the world without worrying about reimbursement. However, it’s important to remember that these laws do not apply to all insurance policies. Some worker’s compensation and small group plans may qualify for an exemption. It’s important that patients check with their insurance company before scheduling a telehealth appointment.

In states without parity laws, many private insurance companies still cover telehealth services. This is especially true now, as more insurance companies appreciate the benefits of preventing the spread of disease.

Using Telemedicine With Global Reimbursements

Global reimbursements allow providers to collect one payment for all services related to a specific condition or event. It’s up to the provider to determine how they deliver service to their patients. Providers receiving global reimbursement can utilize telemedicine to reduce operating costs and increase efficiency. This provides numerous benefits to both patient and provider.

Medicare Coverage for Telemedicine

Patients on Medicare may receive reimbursement for telehealth services as well. However, Medicare coverage is limited. Designed to ensure patients in rural and remote areas have access to care, in order to qualify for coverage, patients must live in a “Health Professional Shortage Area”. This means they do not have access to a specialist where they live.

While patients with Medicare in remote and rural areas can receive telehealth services, they may have to visit a designated healthcare facility to qualify for reimbursement. Using a telemedicine cart, patients and their providers can connect to specialists remotely via telemedicine software during an in-person visit.

Medicaid & Telemedicine

Patients with state-funded Medicaid may also qualify for reimbursement for telehealth services. While every state offers some form of coverage for telemedicine, the requirements can vary. Like Medicare, some states require patients to visit a designated healthcare facility. Others allow patients to connect from their home or office via secure telemedicine software.

Telemedicine Provides a Cost-Effective Alternative to In-Person Visits

As telemedicine becomes more popular, an increasing number of private insurance companies are offering coverage. Even companies that do not offer full coverage for telehealth visits are starting to offer reimbursement under certain conditions. It won’t be long before telehealth services become widely accepted.

Let’s Talk Interactive provides comprehensive telehealth solutions. Please contact us for more information about our secure telemedicine software.