“At the start of the pandemic, many providers and insurers removed copays for visits because they wanted to boost telehealth,” Ellimoottil said. “Now we have copays coming back from major insurers. Ultimately, we don’t know yet what the net effect will be for patients, providers or payers.”
For example, if telehealth leads to more appointments, the costs could rise. According to Ellimoottil’s research, the percentage of secondary visits within 7 days is about 10% with a personal visit. Telemedicine slightly increases the number of follow-ups, which may incur additional costs.
But, Ellimoottil says, it’s just as likely that costs could come down.
“If the patient doesn’t have to pay for transportation, parking, or taking time off to see a doctor, it can cost less than a hospital visit,” he says. “But the question remains how appointments should be billed with telehealth.”
To understand telecare billing, Ellimoottil says you need to understand the things used in billing for personal care. “The same considerations apply,” he says.
- The time involved in an appointment. “As time goes on, so does billing,” he explains. “This has always been the case, even on personal visits.”
- The complexity of the appointment. “The formal term here is ‘medical decision-making,'” says Ellimoottil.
- The amount of data reviewed. “If a doctor looks at an X-ray report instead of the actual image, it’s cheaper,” he says. “Or if they have to prescribe a drug instead of sending the patient home with Tylenol, the costs go up.”
In Heal’s case, the $80 telehealth bill may have been due to the complexity of reading his CT scans and determining a next course of action, which the doctor then had to explain to the patient.
“When I asked about the cost, they told me the doctor spent 35 minutes preparing for the appointment, so it was billed as a full visit,” Heal says.
This goes back to the billing formula.
“Sometimes the appointment itself is short, but because a patient had an acute problem that required testing or a prescription for antibiotics, the bill level is higher,” explains Ellimoottil.
But as with Heal, many patients find it difficult to estimate how the cost of telecare might compare to a face-to-face visit. Is the quality of care equal? In some cases yes, but many patients question that, and with it the associated billing.