Telehealth visits covered for some, but not all

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(Nexstar DC photo)

If you have had a telehealth visit or are planning to you may want to call your insurance company or doctor’s office. As NBC4 found out, some people are making appointments and then hearing they are not being covered and the reason might not be what you expect. 

NBC4’s Hattie Hawks, like many others at the start of the stay at home order had a regularly scheduled appointment and did it virtually. Weeks later she got a message saying the claim had been denied. Ultimately, after some phone calls the insurance company said they were paying the claim. She spoke with Ohio Health leaders about what they are seeing and what you should do.

Since the stay at home order began doctor’s offices have emptied, but their phones are ringing off the hook. “We have seen 83 thousand visits in 5 weeks. There is something here, ” said Ohio Health’s Population health VP of Operations Jim O’Brien. “It’s not like in the era of COVID all of sudden diabetes, hypertension, and heart attack and strokes went away. Those still happen and so our doctors are still providing those much needed services to our patients.” Telehealth has taken off where doctors see their patients virtually.

As with many sudden changes there are complications and insurance is one of them. O’Brien said most insurance companies won’t cover telehealth the same way that they cover in-person visits and their systems are set up to automatically deny those claims. 

“We have been able to tell our providers you need to hold on to your bills for a couple of weeks because otherwise it’s just going to get rejected because that is how the program works until they fix this.” 

Ultimately in this situation, he said, the bill get’s paid but there might be time you don’t get back. 

“It’s a situation where we don’t know that it’s also going to kick a letter to a patient that says ‘hey, your visit wasn’t covered’ and it causes confusion and causes anxiety and that sort of thing.”

Dr. O’Brien said while most companies have adapted to federal government guidelines there could be some who are only covering telehealth during a certain time period and it’s important for you to check your coverage before your appointment. “Every individual can have different timing of when they adopt those and it can be even different from place to place not just state to state.”

Overall, he said the process of seeing patients virtually has been a good thing. He hopes it opens doors for the future of telemedicine for rural communities, those without transportation, and people short on time. 

“If we were able to provide access for frail or elderly or patients who have chronic or medical conditions where they can get their blood pressure checked and their diabetes managed and they don’t have to spend two hours doing so, that could be a real win. Even people with jobs, if you don’t have to take a half-day off of work but you could on your break talk to your doctor, that could be a real win for patients.”

Copyright 2021 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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