Guide to Telemedicine and Insurance during and after COVID-19

Doctor hand working with laptop computer in medical workspace office as concept

The COVID-19 pandemic is changing the way patients want to receive care from their healthcare providers. In a recent survey of 2,000 adults across the United States, nearly three-quarters said they would use telemedicine to undergo remote screening for COVID-19, and two-thirds said the outbreak increased their willingness to try the technology. Thirty-eight percent said they liked the idea of getting a diagnosis without risking exposure in a waiting room; 36 percent liked keeping an appointment without traveling to a clinic or office.

In response to the growing call for social distancing, even within healthcare, many doctors are offering telemedicine to interact with patients. Telemedicine, also known as telehealth, uses an interactive 2-way telecommunication system to connect patients with their healthcare providers. A growing number of private insurance companies now cover telemedicine services, particularly in the wake of the coronavirus pandemic. Many cover medically necessary telemedicine services with no member cost sharing payments.

There are a number of benefits to using telecommunication to connect doctors and patients. Telemedicine can help reduce the demand on doctor’s offices and hospitals, for example, and it is more convenient for patients to check in on a computer or other remote device than to see a doctor face-to-face. The technology can also help keep sick or at-risk patients at home and at a safe distance from others, which became especially helpful during the COVID-19 outbreak.

While telemedicine benefits both patients and providers, many patients have concerns about receiving higher bills for telehealth calls, insurance, and privacy. They may also have questions about what happens if they are uninsured.

Medicare Now Covers Telemedicine for COVID-19

The Telehealth Services During Certain Emergency Periods Act of 2020 allows U.S. Centers for Medicare & Medicaid Services (CMS) to reimburse doctors and other healthcare professionals for using telemedicine to treat COVID-19 and for other medical purposes.

CMS defines telehealth services as “office visits, psychotherapy, consultations, and certain other medical or health services that are provided by an eligible provider who isn't at your location using an interactive 2-way telecommunications system (like real-time audio and video).” From their office or hospital, doctors can connect with patients in their homes, nursing homes, or assisted living facilities.

Medicare Part B (Medical Insurance) covers telemedicine visits with doctors and certain other healthcare professionals. Patients pay 20 percent of the Medicare-approved amount for physician services, and the Part B deductible applies. Patients pay the same amount for telemedicine visits as they would for the same services in their doctor’s office.

Individual states must decide whether to expand Medicaid to include telemedicine services. Low-income and uninsured people in some states may end up paying out-of-pocket for telemedicine services. Direct-to-consumer telemedicine apps, such as Amwell, HeyDoctor by GoodRx and PlushCare, offer low-cost telemedicine doctor visits.

Authorities are looking for ways to help hospitals pay for the treatments they provide to the uninsured. Between 670,000 and 2 million uninsured people in the United States could eventually be hospitalized with COVID-19, according to Kaiser Family Foundation. Hospital reimbursements for those treatments could cost between $13.9 billion and $41.8 billion.

U.S. Health and Human Services (HHS) offers the COVID-19 Uninsured Program Portal that allows doctors and other healthcare professionals to receive reimbursement for the care they provided to uninsured patients for the treatment of COVID-19.

Telemedicine and Safety/Privacy Concerns

As healthcare providers rapidly implement and expand their use of telemedicine, they need to do so with privacy and security in mind. The HIPAA Security Rule helps healthcare providers take the appropriate safety measures when they use telemedicine. This means patients and doctors must use approved computers and other devices, secure internet connections, encrypted transmissions, and secure endpoints for both the doctor and the patient. While the COVID-19 outbreak itself is not heightening security risks involved in telemedicine, the rush to implement and expand existing telemedicine technologies can allow gaps in the maintenance of security and privacy information.

The concern over privacy and security is not surprising, given the rising number of health data breaches and cyber-attacks targeting medical information. About 93 percent of all healthcare organizations have experienced a data breach in the past three years, and 57 percent experienced more than five data breaches in that time. More than 300 have been stolen since 2015, affecting about one in ten healthcare consumers.

While HHS announced it would delay the implementation and enforcement of certain provisions of the information sharing rules to alleviate some of the pressure on healthcare organizations during the COVID-19 public health emergency, HIPAA still requires healthcare providers implement safeguards to protect personal health information from unauthorized disclosures. These safeguards allow patients to use telemedicine safely and securely, even in the tumultuous times of the COVID-19 outbreak.

As the COVID-19 pandemic subsides, patients will likely continue using telemedicine to communicate with their healthcare providers, and insurance companies will expand their coverage of such services.

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