By Anna Wilde Mathews and Robbie Whelan
Insurers are rolling back the terms of telehealth coverage they
launched this spring, with some UnitedHealth Group Inc. and Anthem
Inc. customers set to face out-of-pocket charges on certain virtual
visits starting October 1.
Major insurers are taking different approaches to covering
remote care, which is typically done by phone or video. The
companies are offering an array of deadlines, reimbursement
strategies and charges, depending on factors like the type of plan
or the purpose of the medical visit.
Doctors and hospital officials say the complex rules are leading
to confusion -- and the cost-sharing charges create concern that
patients, faced with an increased financial burden for telehealth,
might delay or avoid visits.
"It's really very complicated," said Ted Okon, executive
director of the Community Oncology Alliance. "It should be
simplified and unified so that you don't have to constantly go back
to this grid."
The new Anthem and UnitedHealth changes, for instance, only
apply to certain plans and don't include virtual visits related to
Covid-19, which will generally continue to be free for patients.
Some other insurers had ended cost-sharing waivers for telehealth
visits earlier in the year.
"Shifting the copayment back to patients now presents a risk
that patients will cancel telehealth appointments or seek in-person
visits that heighten the threat of infections," said Thomas Owens,
senior vice president of Duke University Health System. Though many
people with insurance would be charged only a flat copay for
virtual visits, others might owe the full cost or a share of it,
depending on their plan.
Telemedicine grew rapidly this spring and summer as the
coronavirus pandemic shut down swaths of the U.S. health-care
system. Doctors and hospitals around the country canceled much of
their routine, in-person care and patients stayed home, nervous
about the risk of infection.
Insurers and the federal Medicare program rushed out expanded
coverage for virtual visits, often including reimbursement for
doctors on-par with what they previously received for seeing
patients in their offices.
Consumer surveys by the Deloitte Center for Health Solutions, a
research unit of Deloitte LLP, found 28% of respondents this April
said they had used a virtual visit in 2020. At the start of the
year, just 19% said they had had one in the previous 12 months.
For Karen Smith, a family physician in Raeford, N.C., about a
third of her patient visits in a typical week is now virtual, she
said. The expanded coverage provided a financial lifeline to her
practice and enabled her to stay in touch with patients who were
afraid to come to the office because they feared viral infection,
Patients might be less likely to use the remote visits if there
is a charge, Dr. Smith said: "If they do have to pay, our patients
are not going to accept the service."
Indeed, Linda Robertson, 71, who is Dr. Smith's patient, says
that despite the convenience of telemedicine, a charge for digital
visits would mean she and her husband would do fewer of them. Ms.
Robertson, a retired teacher from Shannon, N.C. who has diabetes
and rheumatoid arthritis, is nervous about the risk of infection
with the coronavirus. With her current coverage, it is unlikely
that Ms. Robertson would owe copays for doctor visits, either
virtual or in-person.
"I can't afford to be paying copays every time I go to the
hospital," Ms. Robertson said. "I don't pay the copays, and if I
did, I would probably miss most of those meetings, I just couldn't
Doctors and hospitals say they are also struggling with
uncertainty about future coverage of telehealth, since many
insurers have said their current policies are guaranteed only until
the end of the year.
Christi Siedlecki, chief executive of Grants Pass Clinic, which
provides primary care in Grants Pass, Ore., said she is worried
that the clinic will lose telehealth payments when the federal
public-health emergency tied to the pandemic lapses, currently set
to happen in late October. "It's not certain what the future
holds," she said. "Everything right now is based on the state of
UnitedHealth is tweaking its cost-sharing policy as "the
health-care system is returning to normal levels," a spokesman
said. The Oct. 1 change affects in-network non-Covid-19 visits for
people with Medicare Advantage and fully-insured employer and
individual plans, the company said.
Anthem said that starting Oct. 1, patients enrolled in
fully-insured employer and individual plans will generally face
cost-sharing for non-Covid-19 virtual video visits with network
providers. But telephone visits -- with no video -- will remain
free of charge at least until the end of the year. The insurer's
Medicare Advantage enrollees will also have no cost-sharing on
video or phone visits at least until next year.
"As offices have been able to reopen, we have aligned our
cost-sharing for telehealth and in-person care for non-Covid
cases," an Anthem spokesman said.
Other major national insurers are taking varying approaches. CVS
Health Corp.'s Aetna said it is waiving cost-sharing for virtual
doctor visits, both specialists and primary care, in its Medicare
plans at least through the end of the year. For those enrolled in
fully-insured employer plans, there are no out-of-pocket charges
for virtual visits for Covid-19 or behavioral and mental-health
counseling. However, in early June, the insurer restored
cost-sharing for other types of telehealth visits for those
Cigna Corp. said it has waived cost-sharing for virtual visits
related to Covid-19 through the end of October for its commercial
plans. Out-of-pocket charges apply for telehealth not related to
Covid-19, the insurer said. Cost-sharing is still waived for
virtual visits by Medicare Advantage members, including those not
Write to Anna Wilde Mathews at email@example.com and Robbie
Whelan at firstname.lastname@example.org
(END) Dow Jones Newswires
September 30, 2020 15:56 ET (19:56 GMT)
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