submitted by Kelly Barrett Sarama, Supervising Attorney
Please Note: Health care information has been updating rapidly. The information in this post is current as of April 1, 2020. Please check back frequently for relevant updates.
What is Telemedicine?
Telemedicine (also referred to as Telehealth) refers to the practice of caring for patients remotely, through the use of two-way audio-video technology such as a cellphone, computer, tablet or other such electronic device to deliver care at a distance. This allows you to communicate with a healthcare provider through phone and video while in your home instead of having to travel to a doctor’s office for an in-person appointment.*
Telemedicine allows you and a licensed health care provider to communicate through live video to discuss your current conditions and needs, and in some cases, you can submit pre-recorded video and photos when live video is not available to you.
*Note: You should consult with your doctor’s office to determine if a telehealth appointment is appropriate for you, or whether an in-person appointment is more appropriate to treat your needs. Some conditions may not be appropriate for treatment through telemedicine. You are not required to use telemedicine and can still make in-person appointments with your providers if you prefer.
Does my health insurance cover this?
Medicaid in New York State currently provides coverage for telemedicine through more than 20 types of providers, including primary care doctors, dentists, physical therapists, psychologists, social workers, substance abuse counselors, and many more. You should contact your provider directly to see if they offer telehealth and accept Medicaid.
Your health care provider must ensure that you are made aware of the following information and rights before providing telemedicine through Medicaid:
- Have the right to refuse to participate in services delivered via telehealth and must be made aware of alternatives and potential drawbacks of participating in a telehealth visit versus a face-to-face visit;
- Are informed and made aware of the role of the practitioner at the distant site, as well as qualified professional staff at the originating site who are going to be responsible for follow-up or ongoing care;
- Are informed and made aware of the location of the distant site and all questions regarding the equipment, the technology, etc., are addressed;
- Have the right to have appropriately trained staff immediately available to them while receiving the telehealth service to attend to emergencies or other needs;
- Have the right to be informed of all parties who will be present at each end of the telehealth transmission; and
- Have the right to select another provider and be notified that by selecting another provider, there could be a delay in service and the potential need to travel for a face-to-face visit.
For a full list of the types of health care providers which may be available to you through telemedicine, and for more information on your rights, visit: https://www.health.ny.gov/health_care/medicaid/program/update/2019/feb19_mu_speced.pdf
Please contact your health care provider directly to learn more about your options. If you are enrolled in a Medicaid Managed Care Plan or a Medicaid Managed Long-Term Care Plan, you can also discuss your telehealth options directly with your case manager.
Medicare Part B covers certain telehealth services at any given time, however coverage is currently expanded due to the Coronavirus Public Health Emergency. Under Traditional Medicare (Part B), for most telehealth services, you will pay the same amount that you would if you got the services in person.
According to Medicare.gov:
Due to the Coronavirus (COVID-19) Public Health Emergency, doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities) as of March 6, 2020. Coinsurance and deductibles apply, though some healthcare providers are reducing or waiving the amount you pay for telehealth visits.
If you have coverage through a Medicare Advantage Plan, you won’t have to pay out-of-pocket costs (called cost-sharing) for COVID-19 tests. They may also offer more telehealth services than what was included in their approved 2020 benefits.
You can contact 1-800-Medicare (1-800-633-4227) to further discuss your coverage and options. If you have a Medicare Advantage plan, you can contact your plan directly for more information. You can also contact your health care providers directly for more information.
Most private health insurance plans include coverage of some telemedicine services. You should contact your health insurance company directly, and also discuss your options with your health care providers.
How do I use Telemedicine?
Your health care providers and insurance plan can give you specific instructions on how to access telemedicine services if and when you need to do so. It is most ideal if you have an electronic device with video capabilities, such as a smart phone, computer, or tablet. Telemedicine may not be an appropriate option for you if you do not have access to such technology.
In order for any insurance to cover a telemedicine appointment, it must be medically necessary for you to be “seen” by a health care provider. Please note that you may be scheduled for an appointment with someone other than your usual provider in some circumstances, with follow up appointments to be made with your usual providers. This will vary depending on your specific health care provider and insurance options.
The best thing you can do is call your provider if you think you need a visit, and discuss all of your options for receiving care at that time.
PLEASE NOTE: All of the information within this post is for informational purposes ONLY, and should not be interpreted as legal or medical advice.