Telemedicine in Healthcare & Its Coverage Under Insurance Policies

The way the world handles doctor visits and telemedicine in healthcare has been drastically different in the last few years. While appointments and consultations started to pick up pre-pandemic, they were sent into overdrive during the pandemic. But it’s not as straightforward sometimes as scheduling an appointment and zooming with your doctor.

The industry’s standards are continually developing to react to the changing times. That’s why understanding basic coverage policies with insurance and staying up to date is key. We are here to help.


What Is Telemedicine or Telehealth?

Telemedicine, also known as telehealth, is the use of technology, such as video conferencing, phone calls, and messaging to provide healthcare remotely. This can include consultations, follow-up appointments, and the management of chronic conditions. 

Telemedicine can be used for a variety of healthcare services, including primary care, mental health, and specialty care. It allows patients to receive medical care from the comfort of their own homes, which can be especially beneficial for people living in rural or remote areas or for those with mobility issues. 

It can be delivered through various platforms such as video conferencing software, mobile apps, and remote monitoring devices. It can also be used to facilitate communication and collaboration between healthcare providers. 

Telemedicine is playing an increasingly important role in healthcare as it allows providers to reach more patients, improve continuity of care and reduce healthcare costs. In this article, we dive into the various benefits and insights of telemedicine.

Benefits of Telemedicine

The list of benefits of telemedicine seems to be limitless. Let’s talk about some of the major ones:

  • Increased access to care: telemedicine allows patients to receive medical care remotely and conveniently at a time of their choosing with more appointment windows.
  • Improved continuity of care: telemedicine allows patients to have follow-up appointments with their providers remotely, which can help to improve continuity of care and ensure that patients receive the care they need promptly.
  • Reduced costs: telemedicine can help to reduce costs associated with healthcare, such as travel expenses, parking fees, and missed work days.
  • Better management of chronic conditions: telemedicine can be particularly beneficial for patients with chronic conditions who need regular monitoring and management.
  • Reduced exposure to infectious diseases: telemedicine allows patients to receive care remotely and can help to reduce their exposure to infectious diseases, especially during a pandemic.

Where Does Insurance Come In?

Telemedicine wasn’t always covered. But when the pandemic hit, many insurance providers began to cover telemedicine in many areas. Family medicine and Cognitive Behavior Therapy were among the most popular. While what is covered varies from state to state, as of now, forty-two states and the District of Columbia will cover certain telehealth services. There are two ways to cover the services. 

  1. Coverage upfront. Most insurance companies and some private insurance cover your costs upfront meaning the bill is sent directly to the insurance carrier. This also includes Medicare
  2. Reimbursement funds are when you pay for the bill upfront, but your insurance policy will reimburse you after submitting the bill to them. 

What’s critical to avoid confusion is to talk with your insurance company directly. Each insurance company will have different policies, and while your insurance company may cover parts of telehealth, you will need to confirm your specific policy does as well. 

COVID-19 Has Its Own Special Section

Covid-19 services have their own special codes, which means there are a lot of existing exceptions. Some services that may not normally be covered are now covered for a period of time. This may not be the case always, but it is consistently regulated and updated by the government. 

Examples of Differences in State Laws

States are incredibly inconsistent when it comes to how telemedicine is used across the United States. Here are a few examples of how it may be different. 

  • Some states require certain technology to perform telemedicine. For instance, Connecticut and Maine require appointments to be made over video, whereas some states are OK with a phone or audio call. 
  • Some states follow what is known as parity laws. Parity laws require insurance agencies to provide reimbursements that are the same rate that it would cost for in-person service. This also means that some companies may not fully reimburse all services. 

What About Coverage of Holistic Healthcare?

Integrative and functional medicine is a holistic approach to healthcare that combines conventional medicine with complementary and alternative therapies. In the field of integrated functional medicine, telemedicine can be used for consultations, follow-up appointments, and the management of chronic conditions.

The coverage of telemedicine services under insurance policies can vary depending on the type of service, the patient’s location, and the insurance company. Some insurance providers may cover telemedicine services for certain conditions or in certain situations, such as when the patient is in a rural or remote area and cannot access in-person care. Other insurance providers may not cover telemedicine services at all or may require the patient to pay extra out of pocket.

It’s important to check with your insurance provider to understand what types of telemedicine services are covered under your policy. As telemedicine becomes more widely adopted, more insurance companies are covering it as a way to increase access to health care.

Additionally, telemedicine in Integrative and functional medicine is still not widely adopted as insurance coverage is not widely available, but it’s a growing field, and many providers are starting to offer telemedicine services, especially as the COVID-19 pandemic has accelerated the use of telemedicine in all healthcare specialties.

Exploring Your Options

Telemedicine has expanded your options to use your doctor and expedite health services. I have used telehealth myself in the past for minor needs and have been very happy with the care I received. Although, I always keep up to date with my local primary care doctor in case I need to make a visit for something that I think would require a face to face visit.  

Checking with your insurance company to take advantage of all the benefits your policy has to offer is the first step. Many insurance carries cover telemedicine like a normal doctor visit. If you have questions about your plan or if you want to see what other health insurance plans are available in your area, you can always reach out to our office for help. 

Then make sure your doctor’s office works with telemedicine practices. If they don’t, it may be your state law. Chances are they do! So this is the perfect time to try it out yourself.