Telemedicine: What You Need to Know

You and many others across the United States are self-isolating or under quarantine due to COVID-19. While inconvenient, these measures will help prevent the spread of COVID-19 to keep our hospitals and ICUs from being overwhelmed.

Practically speaking, what do you do if you get a UTI, feel unwell, need to follow-up with a doctor, or just need a prescription?

If you already have a physician, you may be able to get your needs taken care of by simply making a call to their office.

If you have health insurance, you may have other options for receiving non-emergency care. Many health insurers offer a 24-hour nurse hotline with their plans. Some plans also include access to telemedicine, so you can schedule remote appointments with doctors, receive a diagnosis, and be prescribed treatment from your home. 

Even without health insurance, you can buy subscriptions to telemedicine services. GoHealth, for example, offers subscriptions to telemedicine services. Rates vary based on the kind of subscription you choose.

Here's what you need to know as you evaluate telemedicine services:

• Telemedicine advantages
• Telemedicine apps
• Telemedicine costs
• Telemedicine and COVID-19

For more background on what telemedicine is, read: "What to Expect from Telemedicine"

Telemedicine advantages

Convenience is one of the biggest advantages of telemedicine. You don't have to take time to drive to the doctor's office and sit in the waiting room.

"Telemedicine is a great option for people who value their health, yet may face barriers reaching an office appointment — childcare, time and cost of traveling to the office, taking time off of work, etc. It’s also a wonderful option for patients who would rather get cozy, grab their cup of coffee, and have their appointments in the comfort of their own home," says Ballehr.

Efficiency is another advantage that goes hand-in-hand with convenience.

"Telemedicine appointments are altogether more time-efficient. During a telemedicine appointment, more time is spent with the actual physician compared to an in-office visit. This means no time is wasted!" says Lisa Ballehr, DO.

Telemedicine also helps overcome barriers like access to specialists and makes it easier to access medical professionals for those in rural areas.

And, telemedicine also lowers risk of exposure for medical professionals and patients, which is particularly important during epidemics.

For example, hospitals are using telemedicine technology to screen patients before they walk through the doors. Some apps offer screening to help people understand what risk group they're in for COVID-19. Others are working on developing at-home test kits for COVID-19.

Even with these advantages, telemedicine does have limitations that in-person visits do not. 

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Telemedicine apps

Telemedicine companies have downloadable apps that you can use from your phone. Check to see if your insurer works with a specific app. Depending on your plan, it may be to your advantage to use the app preferred by your insurance company.

You should also check with your doctor to see if they use an app as part of their practice. Some doctors and health care systems will use telemedicine companies to follow-up with patients after they are discharged from the hospital. 

To maintain a cohesive care process, check with your provider to see if they use a telemedicine app or system. This can help you maintain consistency with your care and keep your primary care doctor up to date on your health.

Your preferences for maximizing your insurance coverage and receiving care from your primary care physician will affect what you look for in an app.

"Some apps are intended to connect patients with the app's own providers, which can be a great option for patients who don't have a 'regular' doctor, but others are simply communication mechanisms intended to connect those with existing patient-provider relationships," says Erin Jackson, managing partner of the national health law firm Jackson LLP. 

As you're looking at telemedicine apps, make sure that the app you choose is HIPPA-compliant to keep your medical information secure.

"Make sure it is 100 percent HIPAA compliant. Anything sent via the internet has to be encrypted in a unique way. Make sure that the one your doctor chooses is HIPAA compliant and that your photos, video, and voice are safe," says Yuna Rapoport, MD MPH, Manhattan Eye director and assistant clinical professor of ophthalmology at Icahn School of Medicine at Mount Sinai.

Doing thorough research will help you find a good app. If you already have a health care provider, you can ask them for information on the app they use.

"If patients have any concerns about their online therapy not being secure or HIPAA compliant, they should ask their therapist directly about how they are storing their records and whether their communication methods are HIPAA compliant," Haley Neidich, LCSW says.

Video calls and communication are commonly used in non-medical settings. Ballehr recommends avoiding these services for medical appointments:

"If patients are concerned about patient confidentiality, avoid any appointments over Skype, FaceTime, or any similar programs."

In addition to security, Jackson identifies other questions to ask when choosing a telemedicine app:

"Is it owned by investors or doctors? Are they aggregating the data they receive about patient encounters and monetizing it in some way? Are they HIPAA-compliant? 

It's a surprise to many consumers that not all apps are legally compliant, meaning they don't protect your data and facilitate connections to providers in a way that's legally permitted. Find an app that is legit and focused specifically on offering solid, secure patient care," she says.

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Telemedicine costs

You can usually download an app for free. However, you'll be charged for the services you receive.

Your telemedicine costs will vary based on how you approach it. Some telemedicine services are available through a subscription. Some subscriptions include a certain amount of visits or charge per visit.

Other telemedicine apps do not have a patient subscription fee. However, you'll still pay what your doctor or therapist charges for a visit.

If you have health insurance, you may have some coverage for telemedicine services. Check with your insurer to learn more about how telemedicine is covered under your plan.

"Patients can reach out to their insurance companies directly to ask about coverage for teletherapy services, and whether coverage is possible under their plan or in their state. They should be sure to ask the frequency and number of total sessions that they are covered for, and clarify which mental health providers are covered," says Neidich.

If you're concerned about coverage, it's best to reach out to your insurance company before you receive care.
 
"Patients should definitely check with their insurance company before incurring the charge, as some insurance companies will deny a claim for services that are not covered and not pre-approved," advises Kay Van Wey, board certifed personal injury trial lawyer.

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Telemedicine and COVID-19

COVID-19 has resulted in increased interest and use of telemedicine. As you explore telemedicine during this time, here are a few things to keep in mind.

Telemedicine is feeling a lot of growing pains.

Before COVID-19, telemedicine was becoming more and more common. It helped make accessing care in rural areas easier, especially for seeing specialists. It also made it easier to see a doctor for homebound individuals. 

However, due to the COVID-19 pandemic and moves to lower exposure risk, telemedicine companies are experiencing unprecedented demand and moving quickly to meet it. More people are looking for telemedicine services to avoid being exposed to whatever germs are at the doctor's office. Medical professionals are also using telemedicine services to screen for COVID-19 patients before they come into the hospital.

To accomodate for the rapidly increasing demand, telemedicine app companies are hiring more doctors. However, one tricky aspect of meeting this demand is that doctors are required be licensed in the states where they practice medicine or where their patients live.

Rules around telemedicine are changing because of COVID-19. 

Some new, temporary rules are requiring expanded coverage for telemedicine services by insurers. Federal rules have changed to permit telemedicine coverage by Medicare. This shift is an important protection for elderly, who are at a higher risk for this virus. However, even this positive step doesn't benefit all equally. 

For example, community health centers are exempt from this change. This omission affects 81,000 seniors in Pennsylvania.

Whether or not Medicaid covers telemedicine is being decided by each state.

Check your state laws to see if your state has additional changes to require insurers to cover telemedicine during the COVID-19 pandemic. Your insurer should also have this information. However, as the situation with COVID-19 changes daily, your insurer's representatives may not always be aware of the most recent changes.

"Many insurance companies are now offering telehealth parity — this means that if a service would've been covered for an in-office visit, it's required to be covered at the same rate for occurring via telehealth. If your doctor's office is asking you to pay upfront in full for a telehealth visit and won't file it with your insurance like they would a normal in-office visit, that should raise a red flag that your doctor isn't up on recent changes that the government and insurers have enacted with the COVID-19 pandemic," says Jackson. 

Since insurer choices and state laws can vary, check with your insurer to see how it's covering telemedicine services during this crisis. You should also be aware of any legal changes that have been made to accomodate self-isolation practices.
 
"If you get a denial from your health insurance company for a telemedicine visit during this COVID-19 public health  emergency, you should report them to your state Board of Insurance.  During this public health crisis, 'we’re all in this together' must mean that health insurers and HMOs make it easy and affordable for patients to see their healthcare providers virtually and not have to break social distancing rules in order to receive routine medical care," says Van Wey.
 
As you navigate telemedicine during the crisis, don't overlook security and privacy protections.

"It's also crucial to mention that providers should be careful to comply with their privacy and security obligations. HIPAA has been loosened in some respects, but there's really no reason for a typical provider to offer care via a medium that falls below HIPAA's standards. Aside from creating potential liability for your practice, it puts your patients' privacy at risk," reminds Jackson.