When COVID-19 made its first U.S. appearance some six months ago, insurance providers quickly modified coverage plans to include telehealth visits, paying practitioners the same rates offered for in-office visits and often not requiring consumers to make co-pays. Those two small changes made a big difference in telehealth’s explosion into mainstream U.S. usage nearly overnight.
But now, insurance companies are reportedly taking another look at telehealth, making a lot of changes that went into effect this week. According to The Wall Street Journal, insurers have come up with a series of new reimbursement strategies depending on a host of factors, like the type of plan a customer has or a medical appointment’s purpose. Co-pays that insurers previously waived could now apply.
That’s adding complexity that medical personnel complain is confusing to patients and will ultimately mean they pay more out of pocket for remote care. And that, in turn, will create incentives for them to return to in-person visits or avoid treatment altogether, experts told the WSJ.
“It’s really very complicated,” Ted Okon, executive director of the Community Oncology Alliance, told the paper. “It should be simplified and unified, so that you don’t have to constantly go back to this grid.”
Simplicity, however, doesn’t look to be in the cards. For example, the Journal noted that new rules by insurance giant Anthem and UnitedHealth only apply to certain coverage plans. They also exempt virtual visits related to COVID-19, which will remain free to consumers.
Other insurers have removed co-pay waivers for telehealth visits they’d been offering since the pandemic’s early days, the paper said.
The moves come at a time when COVID-19 caseloads are creeping up in several states. The U.S. Centers for Disease Control and Prevention (CDC) recently warned people to stay away from malls, holiday parties and any other large holiday gatherings, and President Donald Trump and First Lady Melania Trump have been infected with COVID-19.
If COVID-19 cases continue to surge, will insurance companies roll back their rollback and return to their earlier policies on telehealth? Or will they add in additional billing codes and rule tweaks that mostly shut down how much they’re compensating for telehealth visits?
It’s a question where the insurance industry’s level of opacity alone points to a problem. Sesame CEO David Goldhill recently told Karen Webster that the insurance industry as whole isn’t a good fit for the modern world of digitally-enabled healthcare. He believes it’s acting as an anchor against progress and simply needs to go.
“The idea of this insurance-based emergency response that treats a pregnancy like a car crash isn't going to work anywhere in the 21st century,” Goldhill said. “We're just watching these systems fall apart.”
Part of that falling apart, he said, is how many U.S. consumers now pay for healthcare. High-deductible plans mean many Americans pay healthcare expenses out of pocket, since all but the most serious situations rarely cross the deductible's threshold.
Goldhill said the idea that insurance is paying for people's care is increasingly untrue. Unless consumers surpass their plans’ high deductibles — which the vast majority never get close to — they’re actually paying out of pocket.
Goldhill said that’s why Sesame has created a medical services market that just cuts insurance companies out. People pay out of pocket at a rate discounted to what’s often below their policies’ co-pays.
Goldhill said many consumers think they have to choose between good healthcare and cheap healthcare, but he thinks they can have both. He said the problem is that U.S. healthcare payments are a black box that makes it impossible for consumers to understand costs, much less lower them.
And Goldhill has there’s a labyrinth of incentives and subsidies that end up driving the cost of healthcare up rather than down for the average American family.
“We think this [can] be about bringing the marketplace dynamics to an industry like healthcare,” he said.