American Independent Business Coalition Health Insurance – Why are doctors now charging patients for free phone chats? : Shots – Health News As part of their social distancing policies, elected leaders have suggested that phone and video medical appointments be covered by health insurance. So why are some patients paying $70 per virtual visit?
Despite recent insurance policy changes, some patients say doctors and insurers are paying up front for video appointments and phone calls — not just copays, but sometimes the entire cost of the visit, even if it’s covered by insurance. Sesame/Getty Images hide caption
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Despite recent insurance policy changes, some patients say doctors and insurers are paying up front for video appointments and phone calls — not just copays, but sometimes the entire cost of the visit, even if it’s covered by insurance.
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Karen Taylor had been coughing for weeks when she decided to see a doctor in early April. The number of cases of COVID-19 in Texas, where you live, has passed 5,000.
Cigna, its health insurer, said telehealth would waive the cost of out-of-pocket costs for patients to get coronavirus screenings via video conference. So Taylor, a sales manager, talked to her doctor through an online video call.
The doctor’s office charged her $70. She protested. But “they said, ‘No, that goes toward your deductible and you have to pay the full $70,'” she says.
Policymakers and insurers across the United States say they are eliminating co-pays, deductibles and other barriers to telemedicine for home patients who need to see a doctor for any reason.
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“We encourage people to use telemedicine,” New York Gov. Andrew Cuomo said last month after ordering insurers to eliminate co-payments, which are typically collected by the patient during a doctor’s visit.
But in a fragmented health care system — with dozens of insurers, 50 state regulators and thousands of independent doctors — the shift to telemedicine at no cost to patients is going less smoothly than they suggest. Speeches and press releases. In some cases, doctors pay for phone calls that were previously free.
Patients say doctors and insurers charge upfront for video appointments and phone calls — and not just co-pays but sometimes the entire cost of the visit, even though insurance covers it.
Despite promises by politicians, insurers say telehealth cannot immediately eliminate co-payments for millions of card-carrying members who get coverage through self-insureds. Officials at telehealth organizations say insurers have been slow to update their programs and policies.
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“Most insurers that said they won’t pay co-pays for telemedicine — they haven’t implemented it,” says George Favvas, CEO of Circle Medical, a San Francisco company that provides family medicine and other primary care services. Continuous broadcast. “That’s starting to hit us right now.”
One problem is that insurers have waived co-pays and other telehealth cost-sharing for online-only doctors. Another is that Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare and other carriers that promote telehealth have little power to change telemedicine benefits to self-insured employers who process their claims.
Such plans cover more than 100 million Americans — more than the number of beneficiaries covered by the Medicare program for the elderly or Medicaid for low-income families. All four insurance giants say enhanced telehealth benefits don’t necessarily apply to such coverage. Neither the governor nor state insurers can force federally regulated plans to renew telehealth coverage.
Many employer plans are starting to eliminate cost-sharing, such as copayments and deductibles, as federal regulators loosen rules for certain types of plans to improve telehealth benefits, says Brian Marcotte, a union for very large, mostly self-insured employers.
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For many doctors, business and billing have slowed due to the coronavirus shutdown. Despite the new rules, many practices may want to collect telehealth revenue from patients immediately instead of waiting for insurance companies to pay, says Sabrina Corlette, research professor and co-director of the Center for Healthcare Reform.
“Many providers may not have an agreement with the plans they work with to deliver services via telemedicine,” he says. “So these providers protect themselves up front by charging full payment or getting co-payment.”
David DeKeyser, a marketing strategist in Brooklyn, NY, sought medical advice via video after coming into contact with someone who attended an event who was diagnosed with the coronavirus. The office charged his debit card for the entire visit — $280, just a copay — without notifying him.
“It was payday for me,” DeKeyser says — a week early and the payment could have resulted in a bank overdraft. They say the email exchange changed the account.
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With widespread acceptance, telehealth calls have suddenly become an important and potentially lucrative source of income for physicians. Medicare and some commercial insurers have said they charge the same rate for video calls as for office visits.
Some doctors charge for phone calls, which were once considered an incidental and non-billable part of the front office. According to Health Insurance Plans of America, Blue Cross plans in Massachusetts, Wyoming, Alabama and North Carolina pay for patient visits by phone.
Catherine Parisian, a professor in North Carolina, says what seemed like a routine follow-up call with her specialist last month turned into a telehealth consultation with an $80 co-pay.
“What used to be considered a phone call, they’re now paying for as telemedicine,” he says. “Doctors don’t call me without giving me an account.”
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By multiple accounts, the number of video doctors increased after the Department of Health and Human Services said in mid-March it would “take major steps to expand Americans’ access to health services.”
HHS says Medicare has expanded benefits to pay for more telemedicine services nationwide rather than for patients in rural areas and other limited settings. The program temporarily stopped doctors charging patients reimbursements during visits.
At the same time, the CARES Act, passed by Congress last month to address the COVID-19 emergency, allows high-deductible private health insurance to exempt telehealth cost-sharing. Such plans may now pay for video medical visits even if patients do not meet deductibles.
Dozens of private health insurers listed by AHIP say they have eliminated patient co-pays and other cost-sharing for telemedicine. However, Cigna waived only certain out-of-pocket costs — the costs of telehealth appointments related to COVID-19 screening. Cigna did not respond to requests for comment.
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Teladoc Health, a publicly traded telemedicine company, said its volume has doubled since early March to 20,000 medical visits a day. Its share price has also nearly doubled since January 1.
With such strong growth, it’s no wonder insurers and doctors are struggling to keep up, says Circle Medical CEO Fawwas.
“It’s going to be an unfinished process for a while,” he says. “It’s understandable because things move so fast.”
Abby VanSickle, a journalist from California, wanted her child’s scheduled well-being visit to be done remotely because she was worried about visiting the doctor’s office during the pandemic. The pediatrician told her that her insurer, UnitedHealthcare, would not pay for it. Mother and child had to enter.
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“There seems to be such an unnecessary risk,” VanCycle says. “If we can’t make charity visits, we’re certainly not alone.”
A spokeswoman for UnitedHealthcare says there is a misunderstanding and that VanSickle includes a remote visit to the child without the required co-pay.
New York medical anthropologist Jacqueline Grace Lacey had a similar problem. She had to renew the prescription a few weeks after Cuomo ordered insurers to waive patient fees from the cost of telehealth appointments.
The doctor’s office told her she would have to come in for a visit or make an appointment for telemedicine. The video visit came with a $50 “administrative fee” that she had to pay upfront, she says — more than five times the co-pay for an in-person session.
“I’m not going to go to the doctor’s office and potentially expose people to get my monthly medication again,” she says.
Corlette says patients should check with their insurer before any telehealth visit to make sure telemedicine is covered by their health policy. If your employer’s plan does not pay for telemedicine or requires reimbursement, check with your company’s human resources department. A company can change that policy if it is self-insured like most large employers.
“If you know of co-workers in the same boat, encourage them to ask HR,” she says. “HR can pay more attention if the request comes from multiple sources.”
NooFit is an editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente. Our health, daily living and business discounts and benefits programs are designed to help individuals and families cope with today’s rising costs.
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