During the anxiety-fraught early days of the COVID-19 pandemic, most major insurers joined the Centers for Medicare & Medicaid Services (CMS) in waiving co-pays and deductibles for telemedicine visits — cost sharing for telemedicine — in order to encourage people to remain at home, thus reducing possible exposure and transmission of COVID. The public, many of whom were new to telemedicine, readily adopted the technology in favor of convenience and safety, reduced costs, and less travel. Now, however, those halcyon days may be gone. Some major private health insurers have stated that as of Oct. 1, they are no longer paying the full costs for virtual visits that are unrelated to COVID; instead, patients are expected to pay a portion of the costs for the virtual visit, as is the norm for in-person visits.
Patients who wish to continue receiving care via telemedicine are advised to contact their insurers prior to their appointments to learn how much they will owe. For each individual, the specific amount of cost sharing for telemedicine will depend on a number of factors such as the patient’s health plan policy, type of visit, and whether they must reach a deductible before insurance payments begin. Estimates range from $25 for co-pays—the same amount often charged for an in-person visit—to covering the entire telemedicine visit out-of-pocket for patients who have yet to meet their deductibles. Various organizations’ predictions vary from $55 to $400. And some patients, unaware of the change in policy, are receiving surprise medical bills after a virtual visit.
As reported by STAT News, UnitedHealthcare and Anthem have eliminated no-cost telemedicine visits for issues not related to COVID-19. Co-pays, coinsurance, and deductibles for virtual visits—each of which are considered cost sharing for telemedicine—will be reinstated. In early August, both companies had admitted uncertainty about whether they would extend the waivers past early autumn; it seems that this deadline has not changed despite the fact that the COVID crisis is far from over. In addition, private insurers may revert to paying less for a telemedicine visit than a comparable in-office visit, thus eliminating payment parity and removing a major incentive for providers to continue using telemedicine technology.
Generally, providers’ reactions to this news are swinging towards a negative outlook. Considering the high proportion of the population who has been relying on telemedicine to avoid exposure to communicable disease, especially the immunocompromised and those with chronic conditions, some physicians fear that decreased reimbursement payments plus increased cost sharing for telemedicine may favor the more-highly reimbursed in-office visits, resulting in a return to pre-pandemic levels of telemedicine use. Such a consequence could harm patients who feel that the technology is their only option for receiving any care safely, as well as place undue pressure on providers to schedule more in-office appointments in lieu of virtual visits in order to pay the clinic’s bills.
Fortunately, not all the news is depressing. The CMS has pledged that their waivers will remain through the public health emergency, and they have already take steps to make telemedicine reimbursement and use permanent. Some insurers, including BlueCross BlueShield Tennessee and CVS Health, have extended their waivers until the end of the year. To help inform patients of commercial insurers’ policies, the industry trade group America’s Health Insurance Plans monitors telemedicine coverage among commercial insurance companies.
As a result of these changes, patients may be unpleasantly surprised by the new policy of cost sharing for telemedicine. Although coverage is defined by the health insurance companies, patients tend to associate their medical bills with the provider rather than the insurer. To help patients understand the cost sharing and remain loyal to their current providers, it may be advisable for healthcare workers to adjust their telemedicine workflows to include patient eduction on cost sharing; a patient who understands the situation will be more likely to accept the situation and to return for future services.