Many health systems and hospitals have been coping with unprecedented challenges during the coronavirus pandemic of 2020. There has been a need to increase and safeguard healthcare staff as well as non-COVID-19 patients, testing and treating infected patients, expanding critical care unit capacity, procuring personal protective equipment (PPE), and canceling non-emergency patient procedures. The American Hospital Association estimates that healthcare systems are losing an average of 50.7 billion dollars a month. This financial crisis is jeopardizing the telehealth industry as insurance groups seek to lower rates for virtual appointments. Without payment parity equivalent to an in-person appointment, many health care systems will be unable to continue telehealth services.
COVID-19 has brought telehealth from a niche service to a common practice in less than a year. The assurance of physical distance, preservation of PPE, and limiting infection spread has been invaluable. Yet, despite the advantages telehealth provides, insurance coverage, prescribing, and technology access remain limiting factors. The federal government created the Coronavirus Aid, Relief and Economic Security Act (CARES Act) to address these concerns, removing many barriers to promoting telehealth expansion. The Centers for Medicare and Medicaid (CMS) created a toolkit to encourage state Medicaid agencies to adopts CARES Act standards, and many private insurers followed suit. Still, telehealth’s subsequent explosive increase in patients became unprofitable. The resulting financial strain on the healthcare system and insurers may force telehealth provision limitations, although the public health crisis remains.
Early in 2020, the use of telehealth saw an increase from 13,000 to 1.7 million Medicare recipient visits per week. During the height of the national lockdown, between mid-March to mid-June, the number of Medicare recipients receiving telehealth care was more than nine million. Meanwhile, private insurers, mimicking the CARES Act policy changes, saw telehealth claims increasing upward of 4,000 percent from 2019. The CARES Act intended to last until the public health emergency was over. With the advent of this flu season and the possibility of a second wave of coronavirus, there is a call for telehealth’s expansion to become permanent.
However, many private insurers are changing their telehealth coverage policies for non-COVID-19 issues due to financial losses. United Healthcare will no longer waive co-pays and other fees for non-COVID related appointments. Other insurers like Anthem BlueCross BlueShield will extend coverage through the end of 2020; however, only the first two telehealth sessions will be free for the consumer. Telehealth billing standardization remains elusive as each private insurance plan, and many state-funded Medicaid plans have varying rules and dates for what telehealth treatments have coverage. Some patients are paying more, while others are paying less. Costs are confusing, and patients may be delaying healthcare to avoid a surprisingly expensive bill.
America’s Health Insurance Plans (AHIP) is a trade, and political advocacy association of health insurance companies with certifications for Medicare Advantage and other CMS governed health plans. Working with public and private sectors, AHIP implements solutions to lower out-of-pocket costs, which can be a barrier for people seeking telehealth medical care. AHIP’s website lists many insurance providers and general information about their coverage, often addressing telehealth. If you or a loved one requires telehealth coverage, it is the optimal time to review your health care coverage for 2021 as the insurance industry is in its annual enrollment program.
Diminishing coverage for telehealth visits will continue to impact Americans this winter and beyond. Patients are paying more while health care practices are earning less, and the risk of infections increases. Health insurers seem to be driving patients back to the in-person appointment model. Telehealth is truly innovative and protective during the coronavirus pandemic, but its continuation will suffer unless it can also become profitable.
We hope you found this article helpful. If you have questions or would like to discuss a personal legal matter, don’t hesitate to reach out. Please contact our office at (212) 937-8420