When you think of a doctor’s appointment, a few images might come to your mind. You may think of sitting in a waiting room and flipping through a magazine. Or, you might think of the cool feeling of a stethoscope on your skin. You might even think of saying “Aaah” when the doctor checks your mouth and throat. However, some doctor’s visits don’t include any of these things. Healthcare now provides more options for patients who need to see a doctor but don’t want to leave their home. These options are called telemedicine and telehealth.
What is Telemedicine?
Simply, telemedicine is a way for doctors and patients to meet remotely. Using modern technology such as video calls, streaming, and even regular phone calls, doctors can virtually meet with patients. Through their virtual meetings, doctors can diagnose their patients and write prescriptions just as they would in an in-person meeting.
Telehealth fills a similar role, but encompasses a broader spectrum of healthcare. For example, telehealth can include healthcare education, public health, and health administration, as well as clinical appointments between physicians and patients. Telehealth embodies the large scope of healthcare-related meetings and events that can happen remotely.
History of Telehealth
While new technology has made streaming, video calls, and other forms of communication possible, telehealth began several decades ago. In the 1950s, landline phones became widely available to Americans. When people began having landlines in their homes, doctors could meet with their patients remotely. Further, now that technology has advanced, doctors can manage patient portals that tell them what their prescriptions are and what their next steps are.
Benefits of Telehealth and Telemedicine
Using telemedicine as an alternate way to meet with your physician comes with several benefits. For example, patients can save money on transportation and childcare. Additionally, those who meet with a doctor remotely do not need to take time off of work in order to meet with their physicians. Also, patients limit their chances of catching a new illness from going to a healthcare center. They also have less time to spend in the waiting room. Further, accessibility improves with telehealth options. Patients have more on-demand health options and have a better chance of seeing a specialist. Ultimately, telehealth and telemedicine provide many benefits that make these options worth it. If you live in Oklahoma, we want to help you find the telehealth services that are right for you. Please call us at 405-583-4309 for information on how we can help you find services in your area.
Will Medicare or Medicaid Cover my Telemedicine Costs?
If you are considering telehealth or telemedicine, you may wonder if you can afford virtual treatment. Specifically, if you are enrolled in Medicare or Medicaid, you probably wonder if your insurance will cover such treatment. Fortunately, if you are enrolled in Medicare or Medicaid, your insurance will likely cover telehealth costs. Normally, if Medicare or Medicaid deems the service necessary, then they will cover it. However, more specific guidelines have come through the expansion of the telehealth waiver.
Expansion of Telehealth Waiver
On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) passed a waiver. This waiver made telehealth more accessible for those enrolled in Medicare. Ultimately, the waiver states that CMS “has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.” Medicare can fully pay for the following types of services via telehealth under this waiver:
- doctor’s office
- specialist visits
Additionally, many providers such as nurse practitioners, doctors, clinical psychologists, and clinical social workers can also provide telehealth appointments with their patients. Also, the HHS Office of Inspector (OIG) now gives more flexibility to providers. Through this flexibility, OIG can reduce or waive cost-sharing for telehealth visits. This is because they have federal healthcare programs have paid for them.
Another point to consider about reimbursement relates to services. Services covered by Medicaid need to fit in with the federal requirements of three things: efficiency, economy, and quality of care. Basically, these requirements encourage states to pay for telemedicine services consistently. For example, a state could reimburse costs for these types of services: doctor visits, technical support, transmission charges, and equipment.
Medicaid and Telemedicine
Ultimately, telemedicine provides a cost-effective alternative to traditional, face-to-face healthcare. Because telemedicine is cheaper, states can choose if they will provide Medicaid coverage for telehealthcare. Also, states determine where they will cover telemedicine within the state’s regions. Further, states also decide what types of telemedicine providers may be covered or reimbursed. Finally, states choose how much to reimburse for telemedicine services. All they need to do is to stay within the Federal Upper Limits. Although each state handles telemedicine coverage differently, most states’ websites provide more information.
Oklahoma and Telemedicine
Several Oklahoma organizations provide healthcare for OK residents. For example, one of these organizations is the nonprofit Telehealth Alliance of Oklahoma (TAO). Recently, TAO released a statement The organization recently put out a statement comparing telehealth usage of three months in 2019 and 2020. Specifically, TAO compared telehealth in March through June 2019 to telehealth use between March to June 2020. In 2019, 6,989 members used telehealth services. In 2020, however, that number jumped to 78,545. Additionally, 2019’s average refund per member was $140. This year, it was $307. Further, last year physicians conducted 11,941 telehealth visits. In 2020, they conducted 337,415 visits. Finally, the total cost for visits last year was $975,000. This year, the cost rose to $24 million. Clearly, Oklahomans are utilizing telehealth services much more than they were last year. If you are interested in learning more about Oklahoma telehealth and telemedicine, please visit this website.
Will my Insurance Cover Telehealth Treatment?
If you are not covered by Medicaid or Medicare, you are probably covered by a private insurance company. Also, you may receive coverage through one of the Big Five. The Big Five includes the following companies: BCBS, Signa, United Healthcare, Aetna, and Humana. Each of these carriers offer telehealth services in some form, but telehealth is usually still listed as a policy-dependent medical service. A policy-dependent medical service means that a more expensive plan has the service included. However, a cheaper plan doesn’t include the service. Therefore, a gold plan might cover telehealth services while a bronze plan wouldn’t. To find out if your provider covers telehealth, call your provider directly and ask about your policy.
What to Do When You Call Your Insurance Provider
When you call, you need to have a list of questions ready. This way, you can make sure to you take notes on the answers you get. The following outline a few sample questions you could use:
- What is this call’s reference number?
- Does my policy include telehealth services?
- If so, what do telehealth services include?
- Should I use a specific billing code?
- Are there any limitations or restrictions for this service? Is coverage limited to a few times a year?
- To access telehealth services, do I need any special documentation from a doctor?
You need to ask for a reference number so that you will have evidence to prove your case. Further, the representative should be able to answer questions and clarify your issues with coverage.
Does Telehealth Addiction treatment work?
We all have our own expectations about what addiction treatment may look like. For example, you may picture entering addiction treatment and enrolling in a residential program or even an intensive inpatient program. You may also feel that finding a community with others is an important part of the recovery process. To you, a program may involve spending time outside or having group therapy sessions. You may even picture doing animal therapy or yoga. Clearly, telehealth addiction treatment might not match up with the picture of addiction treatment you have created in your mind. However, addiction treatment through telehealth is an effective option to those seeking addiction treatment.
Telehealth programs allow patients to meet virtually with their clinicians through videoconferencing. They can treat their addiction through medication and therapy though these meetings with their chosen clinician. This method helps people who suffer from substance use disorders. It can also assist those with mental health disorders. A 2011 literature review worked to measure the effectiveness of telehealth rehab centers. Of the 50 studies the researchers reviewed, 76% reported that participants found satisfaction from their care. Clearly, telemedicine works for a large percentage of people who are willing to give it a try.
The authors of the literature review agreed that more researchers should conduct studies in the future. It is important to note that the study also found that sustained participation in telemedicine presented some challenges. However, most studies that the researchers reviewed reported evidence of clinical effectiveness for telemedicine.
The Opioid Crisis and Telehealth
Importantly, some programs offer specific treatments for those who suffer from opioid addictions. Several studies examined psychotherapy treatments and found that telemedicine is effective for treating opioid addiction. Many of these studies found that interventions and treatment via telehealth to be effective through medication treatments as well, just like the study from 2011. One of the studies, published by the American Journal on Addicts, examined the retention of 177 patients who received buprenorphine treatments through telemedicine.
The medication buprenorphine helps reverse the effects of opioid addiction. The study found that after one week of treatment, 98% of the patients had stayed active. After one month, 91% of patients had stayed active. Eventually, they found that 57% of patients had stayed active at three months. Out of the percentage of patients who stayed active during all three months, 86% of them had an opioid-negative urine test. Based on these positive results, researchers determined that buprenorphine treatment via telemedicine can be very successful. If you are struggling with an opioid addiction, telemedicine is an effective choice for recovery.
Especially during a pandemic, finding telehealth options for addiction treatment can help many people. If you live in Oklahoma and you or a loved one suffers from a substance use disorder, we can help. Please call us today at 405-583-4309.