Insurance pay-outs during pandemic for telehealth services equivalent to that of in person appointments

by | Jan 17, 2023 | Telehealth News

In a recent study conducted by the Kaiser Family Foundation (KFF), it was found that private health insurers paid similar amounts for telehealth claims and in-person appointment claims during the early stages of the COVID-19 outbreak while virtual care soared. The research was conducted over the first year of the pandemic in 2020. To evaluate the average cost incurred by private insurers for in-person and telehealth evaluation and management services, in addition to mental health therapies, KFF examined approximately one hundred million claims collected by the Health Care Cost Institute.  The researchers accounted for severity levels with respect to claims as well as variation across different providers and areas. From this, it was discovered that private insurance paid extremely similar amounts for online claims, and in-person claims. Through this research, KFF also discovered that in-person and online services received comparable payments for mental health therapy claims through the year. This can be illustrated through the cost of a 30-minute psychotherapy session, which was the same price of forty-eight dollars, regardless of if the appointment took place in person or remotely. The average paid amount for claims supplied virtually was within plus or minus ten percent of that for claims delivered in person, from clinicians who offered both telehealth and in-person healthcare appointments.

A sizable portion of employers utilized in the research, predicted that telehealth would play a significant role in future service access. In comparison to 2015, when less than one third of organizations offered telehealth coverage over ninety percent of employers will offer telehealth coverage in 2022. The pandemic saw a significant uptake of telehealth use, and new studies being conducted to assess the effect of remote healthcare on health spending, payer coverage and payment policies, and federal and state rules, will likely impact the future development of the industry. When the COVID-19 public health emergency ends, three years following its implementation, regulations allowing for expanded telehealth payment and access are expected to be phased out. To give regulators more time to assess the impact of telemedicine before lawmakers adopt new legislation, Congress has granted a temporary grace period  upon the end of the emergency classification.

The future of telehealth is debated in the analysis discussion, where researchers commented the following: ‘Telehealth use surged during the pandemic, but the future of telehealth will be shaped by its effect on total health spending, federal and state regulations relating to scope of practice and reimbursement, and payer coverage and reimbursement policies.’

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