For a sense of scale on the rapid rise of telehealth, consider this: A 2019 J.D. Power survey found that only 1 in 10 patients nationwide engaged in telehealth. By contrast, the Washington Post recently reported that one of America’s largest digital health care providers has seen a 900% increase in patients using telehealth services across its 800 partner hospitals. Closer to home, a recent Stratis Health study found that since the COVID-19 outbreak, telehealth use in Minnesota has increased more than 1,000 fold—from 1,149 visits per day to 15,480. The federal government, which has been reticent to pay for telemedicine except under very specific circumstances (like for those who live in rural areas), has also been quick to expand telehealth benefits and pay providers the same rates as in-person visits.
As with any massive shift, people are wondering just how this system is changing. Since I’ve had a (virtual) front row seat to witness the nimble pandemic response of Minnesota’s nonprofit health plans, I want to share some details on how our member health plans are helping to advance telemedicine. Given that telemedicine can be an incredibly convenient form of care delivery for both patients and health care professionals, we shouldn’t be surprised if its popularity outlives the pandemic. This presents an opportunity for health plans to innovate and create an even more robust telehealth experience
How are telehealth appointments being covered by insurance in Minnesota?
A survey of insurance coverage plans offered by our Council members shows that all of them cover telehealth services for members, and that they will reimburse these virtual visits as if they were done face to face. Hospitals and clinics are being asked to use specific reimbursement codes for remote services, and Council members have set up provider portals to deliver the most up-to-date information on reimbursement codes and procedures. The Council is also working with clinicians to further streamline this process to make it easier for providers, so that enrollees need not worry about whether their appointments will be covered.
Who decides if telehealth is covered?
For people who use Medicare or have their insurance coverage through one of Minnesota’s Health Care Programs, the federal and state governments dictate what services and treatments are covered. Telehealth is no exception. Prior to the COVID-19 health emergency, both the federal Centers for Medicare & Medicaid Services (CMS) and Minnesota’s Department of Human Services had strict rules about how Council members could cover and pay for various telehealth services. Council members have been working closely with people in government to figure out what rules need to be relaxed so people can continue to meet with their doctors, therapists, and other health care providers and get the care they need. Some of the changes made include allowing people to use a variety of audio and visual systems; allowing different types of health care providers – like psychologists, social workers, dieticians, and midwives – to provide care to their patients; and making sure that these providers are paid for this work just like they would be if they saw a patient in their office.
What about self-insured plans?
Self-insured plans – those in which employers use their own funds to cover employees’ claims – can vary, but they generally have the option to cover services the same way as fully insured plans. The Federal CARES Act requires that all testing for COVID-19 and the related provider visit be covered by private insurance plans without cost-sharing (this includes a related provider visit done via telehealth). However, it does not mandate coverage of all telehealth services that are or are not related to COVID-19.
How are health plans letting hospitals, clinics and patients know that telehealth services for mental and behavioral health, as well as other services, are covered?
Council members are providing FAQ documents for health care providers and their members through their respective websites. If hospitals and clinics have additional questions, they are being encouraged to use a plan’s provider portal, or to reach out to the plan’s member services team to answer specific questions, as guidelines for telehealth are quickly changing.
Is there any concern that as telemedicine becomes more readily available and heavily utilized during the pandemic, the cost of mental and behavioral health services will go up?
Minnesota’s nonprofit health insurers care first and foremost about the health and safety of their members and provider partners. Therefore, they should not be concerned that costs for these vital services will rise. A recent MPR article reported that mental health providers are worried that rapid changes governing the way telehealth is delivered (for instance, phone calls versus video visits) could result in providers not being paid for their services. However, this is not the case.
Minnesota’s nonprofit health plans want people to get the care they need no matter which form of delivery is used. As they do with all forms of care, health plans will always monitor the cost of care to limit fraud, waste and abuse. But they fully support the appropriate use of telehealth, especially during emergencies and times of health crisis. So far, we don’t foresee any significant issues on this front.
We recognize that the current situation has people concerned and fearful on many fronts. But those who worry that a telehealth appointment may not be covered by insurance (e.g., a virtual visit with a psychotherapist) can rest easy knowing that Minnesota’s nonprofit health plans are working to address any issues that might arise. We’ll continue to do everything we can to ease the stress and help Minnesotans stay as healthy as possible during this crisis, while also keeping all parties up to date on the latest changes and information.