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How reimbursement works

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In most industries, paying for a service or item is straightforward. You see the price, make the payment, and receive the item or service. The entire transaction takes a matter of seconds. Healthcare reimbursement is far more convoluted. The biggest difference between healthcare and other industries is that providers are paid after services are rendered. Healthcare reimbursement is often a longer process that requires multiple steps, each of which can go wrong at any moment, further delaying payment to the provider and potentially saddling patients with bills they don’t understand and therefore don’t pay. Ultimately, healthcare reimbursement in full isn’t even a guarantee. 

Like other types of healthcare, telemedicine profitability is driven primarily by payers, including Medicare, Medicaid, and private insurance companies. Even within the same jurisdiction, the laws and rules relating to each of these types of healthcare payers can be vastly different, which can create great difficulties for providers, especially providers delivering telehealth services from different states. In most jurisdictions, insurance companies have great discretion in determining how much to pay telehealth services, or even whether to pay at all. It is up to each provider to become aware of reimbursement rules for services they will provide for patients in another state before those services are provided.