Are e-Consultations/Telehealth/Telemedicine Visits Covered by Insurance?

Advancing technology and increased internet access are making an increasing number of personal services available over the internet – including health and medical care.  Telemedicine (which focuses on treating and curing medical problems) and telehealth (which also focuses on prevention and maintenance) are growing in popularity, and many people are now choosing online medical consultations with their physician via video conferencing rather than traditional in-office visits.

As more doctors begin to offer e-consultations, more patients are wondering if their health insurance will cover this new service.  Coverage tends to vary from state to state – some states require insurance companies to pay for the service, and some don’t even have a recognized definition of what telehealth is. The best way to see if your policy will pay for online consultations is to ask your provider.

States Where Telehealth/Telemedicine Visits are Required to be Covered by Health Insurance

There are currently fourteen states in which health insurance providers are required by law to cover online medical visits.

  • California
  • Colorado
  • Georgia
  • Hawaii
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • New Hampshire
  • Oklahoma
  • Oregon
  • Texas
  • Vermont
  • Virginia

The extent of coverage, laws surrounding coverage, and even the established definition of what “telehealth” is varies significantly within these fourteen states.  For example, as of October 2012 the State of Vermont will require all telehealth consultation services to be covered by insurance as if they were face-to-face consultations.  The same bill requires these services to be provided in a medical facility.  Maryland makes a number of additional stipulations in terms of requiring preauthorization, setting a yearly (but not lifetime) maximum for telehealth services, and not being able to distinguish between urban and rural patients in terms of covering eConsultations.

Live Outside One of these Fourteen States?  You Can Still Benefit from an eConsultation

Even if your insurance isn’t legally required to cover your telemedical services, check with your provider – your policy might cover you after all.  It’s also quite possible (and increasingly common) for patients who aren’t covered by insurance to choose online medical consultations over traditional in-office visits.  Patients are free to pay out-of-pocket at many universities and private clinics nationwide, and often the convenience of having an in-home visit rather than going to the office makes the cost worthwhile.  Florida has been a leading state in the adoption of online medicine, offering services through the University of Florida’s Center for Telehealth and Healthcare Communications as well as through the University of Miami’s Miller School of Medicine.

Though there are currently few black-and-white answers about telehealth services, telemedicine is rapidly gaining a huge following and is becoming more and more accepted each year.  At this stage, it’s recommended for patients as well as healthcare providers to check with the insurance company in question before requesting, providing, or billing for online health services.

Learn how you can provide telehealth services to your patients with an online patient portal.

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