Telehealth coverage laws require health plans to cover services provided via telehealth to the same extent the plan already covers the services if provided through an in-person visit. The laws do not mandate the health plan to provide entirely new service lines or specialties, and the scope of services in the enrollee’s member benefits package remains unchanged. The only difference is that the patient can elect to see his or her doctor via telehealth rather than be compelled to drive to the doctor’s waiting room for an in-person consult.
Telehealth coverage laws also frequently include language to protect patients from cost-shifting. They disallow health plans from imposing different deductibles, co-payments, or maximum benefit caps for services provided via telehealth. Any deductibles, co-payments, and benefit caps apply equally and identically whether the patient receives the care in-person or via telehealth. Such language prevents the patient from being saddled with higher co-payments to access care via telehealth.
Some states, particularly those that have enacted telehealth coverage laws in the last few years, have elected to expand on telehealth coverage by also requiring health plans to cover remote patient monitoring. Remote patient monitoring includes a variety of patient oversight and communications devices, software, and processes to allow providers a greater ability to monitor patient care needs and immediately respond. States have taken this step because remote patient monitoring, by definition, is a virtual distance-based service and does not have an in-person equivalent that would likely already be found in a member’s benefit package.
States that have enacted telehealth commercial insurance coverage laws include:
- District of Columbia
- New Hampshire
- New Mexico
- New York
- Rhode Island