Starting Oct. 1, several private health insurers will no longer fully pay for virtual visits under certain circumstances — effectively reinstituting costs for patients reliant on the virtual care that has been heralded as a lifeline at a time when Covid-19 is still killing more than 700 Americans each day.
The insurance giant UnitedHealthcare is ending a “virtual visit” benefit that had been expanded to many members during the Covid-19 pandemic, through which it was covering the full cost of visits — without any cost to patients — for individuals who were seeing in-network providers virtually for medical issues not related to Covid-19. (Asked by STAT for details, a UHC spokesperson pointed to a page on the company’s website.)
And Anthem, the company behind a number of affiliated health plans across the country, will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to Covid-19. Beginning Oct. 1, a commercially insured “member’s cost shares will be applied based on the terms of the plan they purchased,” the spokesperson said, adding that Anthem-affiliated health plans “have a long history of covering telehealth visits.” The spokesperson did not return STAT’s request for details about the coverage changes for different Anthem-affiliated health plans.
As the pandemic gained steam this past spring, both commercial insurers and government payers made rapid changes to the way they covered virtual visits. In many cases, they offered for the first time to pay for telemedicine for certain issues, or to reimburse for it at the same rate as traditional in-person visits. That enabled telemedicine to become a vital resource during the crisis, particularly for the elderly and for people with medical conditions and vulnerable family members who could be put at risk if they were to venture out for an in-person visit to the doctor’s office.
“I think it’s irresponsible to decrease payment for the kind of care that so many patients are receiving. For many patients, it’s their lifeline right now — it’s the only way that they’re feeling comfortable or safe receiving care,” said Adam Licurse, executive director of the virtual care department at Brigham and Women’s Hospital and Faulkner Hospital in Boston.
Licurse, a primary care physician who provides virtual care himself, said the need is especially pronounced in the “many parts of the country that are unfortunately dealing with a lot of higher Covid incidence right now.”
For patients seeking out virtual care, what cost-sharing for an appointment actually means can vary widely from one plan to the next. Depending on the nature of the visit, a telehealth appointment can cost in the ballpark of $100 to $400, and cost-sharing passes some fraction of that down to the patient or their clinic or hospital, which might, in some cases, voluntarily cover all or part of the cost so that the patient doesn’t have to shoulder it.
It’s not clear yet how much patients affected by the changes being implemented this week can expect to have to pay for telehealth visits, nor is it clear how those costs will compare to copays for an in-person visit.
A spokesperson for Anthem declined to provide any numbers when asked by STAT for a rough figure on anticipated fees for patients or costs that might be shouldered by providers helping cover cost-sharing. “It would be misleading to provide a ballpark cost share figure because it not only varies plan by plan, but also member by member depending on whether or not the member has an annual deductible and, if they do, whether or not they have met that deductible,” the spokesperson said.
UHC did not return STAT’s request for the same estimate, but UHC’s website says that patients might generally expect to pay $50 or less for a virtual visit.
Some commercial insurers — including CVS Health and BlueCross BlueShield Tennessee — that had been planning to end their expanded telehealth coverage this week have already extended their Sept. 30 expiration date until the end of this year, and others could still follow suit in the next few days.
When patients learn in advance that their insurer will not cover a telemedicine visit in part or in full, they may proceed in one of several ways: The patient may opt to go through with the virtual appointment anyway. (Depending on its policy and resources, the hospital or clinic may shoulder the remaining cost, or it may require patients to pay all or part of it.) Alternatively, the patient may decide to instead go into the office for a traditional in-person visit, or forgo seeing a clinician entirely.
Then there’s the scenario in which patients learn after the fact that their telehealth visit wasn’t fully covered: In some circumstances patients could get hit with a surprise bill, although many medical practices strive to ensure that doesn’t happen.
The shifting coverage for telemedicine visits is throwing a wrench into the decision-making equation for patients. Several physicians interviewed for this story said that even the prospect of expanded coverage expiring is sowing confusion about what kinds of visits will remain covered, whether they’ll be fully or partially paid for, which insurers will cover them, and for how long.
“What’s been on my radar has been generally the uncertainty and constantly changing dates that the insurers have on their websites, which has just created a sense of uncertainty about where we’re headed,” said Ateev Mehrotra, a hospitalist whose research as an assistant professor at Harvard Medical School focuses on telemedicine.
Licurse worries in particular about the effect that uncertainty could have on small medical practices with tight margins and little room for error, which might not be able to afford to help patients shoulder cost sharing or to lose on an expected stream of telehealth revenue. “To have a provider feel financial pressure to offer less telehealth and bring more patients into the office — because they have to pay the bills and keep the lights on and keep their practice running — is a pressure providers shouldn’t have to face,” he said.
The pandemic-era surge in interest in telemedicine has sparked calls to make expanded coverage of virtual care benefits permanent — especially since the pandemic and its effects are slated to linger in some form for at least another year. But some insurers — and even providers who like the technology — are balking at the idea because of concerns about overuse of health care resources.
“The very advantage of telehealth — the fact that it makes care more convenient — is also its Achilles’ heel, in the sense that it can make care too convenient,” Mehrotra said. The ease of conducting a visit via smartphone from home may lead patients to see their doctor in instances in which such a visit wasn’t necessary — a concern for health insurers worried about their bottom line, and for the system as a whole as health care spending soars.
Compared to private insurers, government payers may be more amenable to making pandemic-era telehealth changes into permanent policy. The Centers for Medicare and Medicaid Services’ waivers are in effect until Covid-19 is no longer considered a public health emergency. In August, the agency proposed codifying some of them and, as a stopgap measure, extending the expiration dates through the end of the year.
Meanwhile, commercial health insurance trade group America’s Health Insurance Plans, or AHIP, which is tracking the extensions among commercial insurers, said it was “still awaiting information on what changes will remain in place beyond the public health emergency.”
AHIP did not respond to STAT’s request for comment about why the changes were not made permanent among private health plans, but instead pointed to an infographic on its website that read in part: “Many changes have been made during the Covid-19 crisis to significantly expand the use of virtual care. If these changes go away, telehealth may be rolled back rather than becoming a sustained and transformational approach to patient care.”
Todd Ray, a senior vice president at BCBS Tennessee, said in a statement that the plan’s decision to extend expanded telehealth coverage beyond Oct. 1 will remove a potential barrier to care for enrollees.
“We’re supporting our members who want to get their routine and preventive health services knocked off the ‘to-do’ list. This is especially important as the Covid-19 pandemic continues and flu season approaches,” said Todd Ray, a senior vice president at BCBS Tennessee, in a statement. BCBS Tennessee’s policies only apply to seniors who are part of private Medicare Advantage plans.
Neither company responded to STAT’s request for the amount that patients would be expected to pay without the waivers, saying the cost varied by individual plan.
Mehrotra said he wants to see all private insurers pledge to pay for telemedicine visits — either via phone or video — at the same rate as in-person visits for the duration of the Covid-19 public health emergency, as defined by the federal government. At that point, “each insurer can choose whatever decision they want about telemedicine policy — we can have that debate now or later — but for now I think we need that certainty,” Mehrotra said.