telemedicine charges during COVID, Massachusetts version
May 26, 2020 6:29 PM   Subscribe

I saw the headlines on Massachusetts 'expanding telehealth' during COVID to keep us from making unecessary trips to the doctor's office for things that could be handled by phone...but what does it mean in $$$ and cents?

So I had a telehealth visit for a regular followup rheumatology appointment, and now just got the EOB and I'm kind of shocked at what the charge looks to be. I expected it to be the same as my usual copay, if not less (see below), but instead it's twice as much and billed under services rather than a copay (so a deducible I'm paying 100%). I was wondering what the expansion of telemedicine means in terms of what I should be paying? Should it be the same as the visit it was replacing? How can a visit that would normally be covered by copay now be something that a deductible applies to?

The appointment was switched to telephone call at the doctor's request, not mine, and she specifically told me during the visit not to come in for blood work (in-person) for at least another month.

I am almost always underwhelmed by these visits - my previous doc required a visit once a year to renew prescriptions but otherwise left it to me to only make appointments if I was having problems. This new one wanted me in every three months and I've talked her down to four or five, and the visits typically go like, "So what you brings you in?" "Umm, you required me to come in or wouldn't fill my prescription." "Oh, um ok. So any problems?" "Nope." "OK, see you in four or five months." And then the receptionist has already scheduled the next appointment without even asking me. At least, I can usually make these in-person visits coincide with blood work. But this telemedicine visit was literally that convo above and some murmurings about COVID precautions, with nothing else... how can it cost more than a usual visit?
posted by Tandem Affinity to Health & Fitness (7 answers total)
None of my regular docs are doing telehealth as yet, but my insurer has a telehealth service (mostly staffed by RNs and NPs, I believe) Those are billed as normal copays. Of course, being run by my insurer, they damned well better not be more than the copay. I have no idea how telehealth will be handled once my docs start offering it.

You might want to talk to your insurer and straight-up ask how telehealth visits are supposed to be billed. Your doc may have used the wrong code when billing.
posted by Thorzdad at 6:45 PM on May 26, 2020

You need to talk to your insurance for specifics first—they dictate what they will pay, how it’s covered. Many insurers are treating telemed visits the same as in-person (in terms of co-pay etc). But especially with COVID, when many health systems had to rapidly switch to telemedicine to continue providing care, it’s all kind of a mess.
posted by namemeansgazelle at 6:49 PM on May 26, 2020 [1 favorite]

It's really all over the place. I have therapy that now happens over the phone and it's billed as if it were an office visit, exactly the same. My doctors here don't do telemedicine but my insurance company contracts with a company that does it (for basic stuff like sinus infections, rashes, I'm not sure what else) and that service charges you directly, at about the same amount as a co-pay would be. It's weird but it means that for me if I have a sinus infection it's cheaper for me to use telemedicine and I can get seen right away even on a weekend whereas I'd be waiting a week for a doctor's visit many times. Some insurances don't really cover telemedicine for some things but it's on them to explain this and have a reason.

I'd call the insurance company and bug them about this.Your logic is sound, particularly if this was a doctor's office instigated change.
posted by jessamyn at 7:04 PM on May 26, 2020

If your insurance company is as frustrating to contact as mine, I'd start by asking the doctor's office about it.

(Through my insurance company, telehealth is covered the same as in-person visits, AND they're even waiving copays for them right now so they're 100% free.)
posted by metasarah at 7:15 PM on May 26, 2020

From the doc's perspective, there are two possible billing options for telehealth. One is a "synchronous audiovisual visit" (aka video visit) which uses the same codes as a regular office visit, and the other is a "telephone chargeable" which is time-based and has new billing codes. There is an older telephone chargeable code as well, at a flat rate not time-based. If the EOB includes the codes submitted by the doc, this one starts with G instead of 9 like the time-based telephone codes.

The way your insurer handles telehealth depends on them. Most are treating it as equivalent to in-office. But if your insurer or doctor's office wasn't prepped for the whiplash change to telemedicine, it's quite likely that someone checked off the wrong box, somewhere down the line. This is especially possible if the visit happened in March or early April, when billing/coding requirements were changing literally every couple days.
posted by basalganglia at 1:53 AM on May 27, 2020 [2 favorites]

The emergency order from back in March (PDF) requires insurers to pay providers the same for telehealth as they do for in-person visits but it doesn’t seem to have any requirement that the same cost sharing requirements apply for patients (unless it’s COVID-19 related), which seems like a big problem. My insurer (BCBSMA) says that they are “waiving cost-sharing for telehealth appointments” which definitely makes it sound like they don’t think they are legally required to do that.

But I would start by talking to your insurance company, it won’t hurt and could help.
posted by mskyle at 4:26 AM on May 27, 2020 [1 favorite]

Who is your insurer? Harvard Pilgrim Healthcare (in MA) is currently waiving copays on telemedicine. I don't know specifically if there are other ways in which the category of visits changes and becomes more expensive.

I'd suggest you call your insurer and talk to them about it, and push back if necessary. This doesn't seem right at all.
posted by Winnie the Proust at 6:35 AM on May 27, 2020

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