• Ariel Chen

Check Your Benefits Before Zooming Your Doctor

Last night, I logged into my insurance account to manage some medical bills. I realized that the telehealth tap was removed from the main page. It took me a while to find the telehealth scheduling window. Additionally, the frontline message changed from “schedule your telehealth consultation for free” to “understand your benefits and coverage for telehealth”. Really? The complimentary virtual visit right is ended even the COVID-19 is killing more than 700 Americans each day? It shocked me even more than the moment when I realized telehealth is offered without any out-of-pocket costs.

We have long seen the potential of telehealth, providing health care remotely with technology, which has been around for several decades. So, what caused the sudden changes?

Due to the financial strain on health care systems and insurers, the increase in telehealth use may be forced to shrink even though the public health crisis remains. Making telehealth coverage expansions permanent is leading people to use their insurance coverage more often by making care more convenient, thus costing private insurance companies more money.

1. Fast adoption

At the very beginning of the pandemic, the use of telehealth went from 13,000 to 1.7 million visits per week among Medicare recipients. Between mid-March and mid-June 2020, during the height of the national lockdown, over 9 million telehealth visits were conducted for Medicare recipients. Private insurers, who mimicked the CARES Act policy changes, also reported exponential increases – with telehealth claims increasing over 4,000% from the previous year.

2. Provider Compensation

Historically, telehealth has been reimbursed at a lower rate than in-person care. The CARES Act had addressed this payment disparity by mandating the same rate for telehealth visits as in-person visits for those insured by Medicare, resulting in more than 80 new telehealth services being reimbursed at the same rate as in-person services.

As of Oct 1st 2020, several big private insurers such as Anthem and UnitedHealth, have shifted their policies for telehealth, meaning that cost-sharing for some visits is no longer waived. These changes apply mostly to non-coronavirus related visits, and to people not receiving Medicare.

In my opinion, a continued increase in COVID-19 cases is expected during the holiday season, just as insurance providers are starting to decrease coverage for telehealth visits. However, virtual visits will likely remain a popular option as the pandemic continues and both patients and doctors experience its advantages, such as saving personal protective equipment, eliminating travel time and keeping social distance. It is important to prepare for your next virtual visit. To avoid a surprise bill, you may want to log into your benefits account to determine your telehealth coverage. Do not be surprised about the co-pay or limits placed on free sessions. An alternative option is to find your own telehealth platform where has its own in-network physicians to take care of your health. A subscription or per-visit fee may apply based on your selection. Don’t hesitate to speak to MicMD to find the right plan for you and your family.