Telemedicine Reimbursement

Telemedicine—using electronic communications to exchange medical information—is growing in popularity. It is convenient for both the patient and the provider, and it delivers good outcomes. Telemedicine is also less expensive than caring for patients solely by means of in-person consultations.

Of course, even though telemedicine is less expensive than traditional consultations, it still costs something. For most people, that means having insurance that will cover the services. The question of whether a particular policy will provide coverage is a matter of state law. While no state says that insurance may not cover telemedicine services, not every state says that telemedicine must be covered by all insurance plans.

In seventeen states, Medicaid or medical assistance must cover telemedicine services, but there is no requirement that private insurance provide coverage (North Dakota law requires telemedicine coverage by Medicaid and state employee insurance plans, but no private insurance). On the other hand, two states—Connecticut and Massachusetts—require private insurance to cover telemedicine, but have nothing that requires Medicaid coverage. Three states—Florida, Kansas, Rhode Island—have no telemedicine coverage requirements for either private insurance or Medicaid.

The remaining 28 states and the District of Columbia all require both private insurance and Medicaid to cover telemedicine. There still are restrictions in coverage. A state may place geographic limitations on coverage. In Arizona, for example, telemedicine coverage is required only for services rendered in a “rural area.” A rural area is an area located in a county with fewer than 900,000 people (i.e. every county except Maricopa or Pima Counties), or a city or town located in a county with more than 900,000 “and whose nearest boundary is more than thirty miles from the boundary of a city that has a population of 500,000 or more.” Telemedicine services to Medicaid patients in North Dakota will be reimbursed only if the patient and the provider are at such a distance from each other that the patient does not have readily available access to specialized services allowed or reimbursed by ND Medicaid via telemedicine.

As a rule, the states that require private insurance reimbursement for telemedicine services say that coverage must be provided in the same manner as if the services were rendered during an in-person consultation. Other rules regarding coverage, such as a requirement that the service be necessary, will still apply. Telemedicine is treated the same as any other medical service. The only difference is how the patient receives the treatment.


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