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Understanding How Insurance May Affect Your Telehealth Visit

As telehealth has become increasingly popular many patients are questioning how this may affect their insurance. Insurance in general can be very confusing and with the constant changes caused by covid it has become even more difficult to understand. 

The laws at the Federal level are very broad and they are further interpreted by the states who make their own policies based on the federal suggestions, these state policies are often more limiting. There is no uniform set of guidelines regarding insurance coverage for telehealth because the states cannot come to an agreement which makes it difficult for government policymakers to create one standard for all states. Furthermore, each insurance company has their own set of principles regarding virtual care. Below are some possible insurance providers and how they might approach telehealth coverage. 

Telehealth coverage also differs by provider which makes understanding your coverage even more tricky. If you have private health insurance you are also subject to a different realm of coverage specific to your plan and provider. Most of the big names private insurance companies offer some coverage for telehealth services but it is important to contact your provider to understand what your plan covers. 

Under Medicare most telehealth visits are covered but they see them as a normal doctor's visit so the 20% co-pay still applies. The Centers for Medicare and Medicaid Services provides a list of telehealth services that are covered but these are subject to change with the pandemic. 

For those who are covered by Medicaid telehealth services are usually covered but defer to the state regulations.  Medicaid providers usually defer to the most cost effective option which at times may require you to take your visit in person rather than virtually. 

It may seem difficult to navigate the fields of insurance when it comes to telehealth. To make your telehealth experience as smooth as possibly it is important to check with your doctor to see if your insurance is accepted at their office. Then you should discuss your insurance plan with your provider to understand what telehealth services they cover. By knowing these facts you will be able to take advantage of all the benefits telehealth has to offer.