COVID-19 Insurance: US Insurance Regulators Require Increased Access To Telemedicine

Before the emergence of COVID-19, telemedicine had rather limited use by hospital and healthcare organizations, most often being employed for post-acute care follow-up visits with established provider-patient relationships, or for interim visits with patients suffering from ambulatory injuries. Some of the reasons for such limited utilization included strict rules by states requiring such things as initial in-person visits to establish the provider-patient relationship, or requirements that telemedicine visits only be conducted by video and requiring strict compliance with HIPAA privacy rules, sometimes challenging providers and patients alike to find private spaces in which to communicate. The insurance industry also contributed to the challenges by compensating providers at lower rates for telemedicine visits, creating a financial disincentive for providers to encourage patients to utilize telehealth services.

As realization that COVID-19 was easily transmissible among humans, health care organizations quickly realized the value that telemedicine could bring to help limit the opportunities for the virus to spread among healthcare providers and patients, alike. State insurance departments were among the professional organizations that took swift action to increase the availability and utilization of telemedicine services.

The National Association of Insurance Commissioners (NAIC) has been tracking actions taken by state insurance departments on issues related to the COVID-19 pandemic, and a database on the NAIC website shows that at least 44 of the 50 states and D.C. have issued one or more bulletins to health insurance companies licensed in their states with respect to the use of telehealth services. Of these 44 states, 27 have issued outright orders, directing insurers to take certain actions. Another 18 have made requests to insurers, while the remaining have published notices about the use of telemedicine to help combat COVID-19.

Telemedicine is most commonly thought to involve the use of a video to link the provider with a patient. The insurance regulators have now expanded the concept to include a much broader range of technologies for the delivery of services including by phone, audio/video, secure text messages, email or a direct patient portal. Other common directives and requests include:

• Orders to expand telehealth services to all covered services under health insurance plans
• Mandating that requirements on use of telehealth services be no more restrictive or less consumer-friendly than in-person requirements
• Prohibiting the requirement of a previous patient-provider relationship
• Reimbursement for telemedicine services at the same rate as in-person visits
• Requiring the inclusion of mental health services through use of telemedicine
• Authorizing out-of-state physicians to practice telemedicine in another state
• Allowing providers in quarantine to practice using telemedicine
• Prohibiting cost sharing (i.e., co-pays, deductibles, and co-insurance payments), particularly for COVID-19 related illnesses and balance billing
• Including short-term limited duration plans and limited benefit plans among the insurers that must provide coverage for telemedicine services.

It remains to be seen whether the increased use of telemedicine services, and the easing of some of the prior restrictions, will remain once the COVID-19 pandemic has abated. In the meantime, however, health care providers and hospital organizations are having to make substantial financial investments in the equipment and training necessary to meet these mandates and expanding demands. And patients who have recently used telemedicine have expressed high levels of satisfaction with the services, a large percentage of whom indicated that they would now include in their selection of a health care provider whether telehealth services were available. COVID-19 has undoubtedly changed the minds of many who previously sought to limit the use of telemedicine services, as well as the way future health care services will be delivered.