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Insurance data reports are revealing a trend: Patients are forgoing traditional in-person office visits to get health care over the Internet or phone, often from providers miles away.

That’s called telehealth. Agents should understand what telehealth is, why patients use it, and how to advise clients about getting it covered.

1. What’s Telehealth?

Telehealth isn’t a particular service—it’s a means of delivering services virtually, over the Internet or by phone.

Many services can be provided this way, including clinical diagnosis, monitoring, management and education.

Telehealth can be a doctor confirming a diagnosis with a specialist over video chat, or a nurse checking a homebound patient’s vitals through electronic monitoring.

2. Why Telehealth?

Patients may live in underserved areas, have difficulty leaving their homes or prefer the convenience of not traveling for care.

A provider, such as a hospital, might want to treat frail patients through telehealth at home.

Or, patients might seek referrals for specialists they cannot travel to for care.

3. How Does Insurance Cover Telehealth?

The good news for your clients is that even though not all states require insurers to cover telehealth, more insurers are covering it than ever before—even when that’s not required by law.

However, even in states that require some coverage, insurers may not be required to cover all types of telehealth. Further complicating things, insurers may cover telehealth under one policy but not another.

If your clients plan to schedule a telehealth visit, have them read their plan documents or call their member assistance service first. They should ask if their plan covers the telehealth they will get, and if there are any coverage differences.

For example, they may have to have an in-person visit with the provider first, or there may be a limit on total telehealth visits per year.

Medicare covers telehealth (with some restrictions) and Medicaid telehealth coverage varies by state.

Read Taking Advantage of Health Care Transparency Trends on ThinkAdvisor.


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