Medical technologies have developed not only in terms of equipment but also in providing healthcare services at the ease of one’s hand. Telemedicine is a term referring to giving medical advice and prescriptions via video calling or other convenient methods.
Tele-Medicine practice has reached to more than three-fourths of the hospitals in the United States. The practice of telemedicine reduces costs and is convenient for the patient.
The combination of technology and healthcare skills raises questions for the insurers as to how much should they cover for their clients. Some insurance companies cover the telehealth costs to a certain extent, while others resist paying anything.
Specific conditions for reimbursement are required :
Insurance firms have highlighted a few requirements for the telehealth service to be reimbursable.
Medicare, the federal program providing healthcare to differentially abled and above 65 residents, requires the beneficiaries to be living in certain rural or outside a metropolitan statistical region to be considered for reimbursement.
Moreover, the patient needs to be present at a nearby “originating site”, which includes nursing homes or rural health clinics, etc.
- Lack of pay parity: The terms and conditions of private insurance providers do not guarantee payment similarity in the telemedicine and in-person scenarios.Most US states allow private insurers to reimburse medical costs while emphasizing that refunded amount should not exceed the cost of reimbursement if the beneficiary were treated in-person.No enforcement is provided on the parity laws in these states, while others do not allow private insurers to stand for reimbursements.
- Insufficient information about various insurance providers: Although insurance providers such as Medicare, Medicaid and private insurance companies fall under the same jurisdiction, the rules related to medical billing of telehealth services may be completely contrasting. Not all insurances have caught with the trend of telemedicine, while others face great discretion in setting a fixed value to reimburse for telehealth facilities.
- Lack of expertise of the Telehealth provider: Telemedicine could greatly boost the costs of treatment if the telemedical staff misdiagnoses the beneficiary. It could raise the stakes for reimbursement to be covered by the insurer. Quality of counselling may greatly vary from one provider to the other. Wrong or unnecessary prescriptions could lead to a worse health condition of the patient, due to which he might have to attend urgent care. This unnecessary billing leads to the discretion of the insurance firms.
- Role of intermediaries: These are links between the healthcare facility and the patient. These vendors provide technology to transfer a required service from the provider to the beneficiary over long distances. The insurers need to attend to the costs of the links as well because they need to provide reimbursement for healthcare service as well as technology.
While attending to the funding obstacles, it would be a reasonable consideration that telemedicine has also provided effective results, as in the case of the decreasing number of patients in the emergency rooms. In this healthcare scenario, on the front-end, expert education of the medical practitioners should be considered.
This will help the patient to gain useful knowledge and will lead to a decrease in the discretion of insurers for telemedical reimbursements.