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Getting Paid for Using Telehealth to Keep Women Alive Is Hard: Startup Exec

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Telehealth startups have been promoting their services with high-powered, venture capital-fueled publicity campaigns for years.

State and federal regulators, and health insurance trade groups, have been organizing all kinds of activities related to telehealth reimbursement for years.

(Related: $1.6 Trillion Emergency Spending Bill Ices Out Health Insurers)

Health insurance agents and brokers may feel as if health insurers must have figured out how to pay for telehealth services by now.

In the real world, however, telehealth services reimbursement is still at such a primitive stage that ob/gyns who want to use telehealth systems to monitor pregnant patients often have to pay for the services out of their own pockets.

Juan Pablo Segura, the founder of Babyscripts, talked about telehealth billing problems in a recent interview.

Segura, a Certified Public Accountant who started out as a consultant at Deloitte, has developed a two-way app that ob/gyns can use to educate their patients and pull patient information into a patient tracking screen. The tracking screens can help ob/gyns identify patients who may need extra attention.

The patients who look as if they are doing well may be able to skip a few routine prenatal care visits.

The patients who do need extra attention get Mommy Kits. Each kit includes a scale and a blood pressure monitor that can report back to the ob/gyn through the Internet.

Segura would not say how much the service now costs. In 2016, a Pennsylvania hospital testing the system told that the starting price of the system was about $300 per pregnancy tracked.

In theory, the Babyscripts system could help ob/gyn address the kinds of problems, such as severe eclampsia, that can lead to babies being born after just 26 weeks of gestation and $1 million NICU bills.

When Segura started talking to payers three years ago, however, he ran into problems.

“It’s hard to work with payers, ” Segura said.

Here are five other things Segura said about insurance coverage and remote pregnancy monitoring services.

1. Remote pregnancy monitoring itself is an issue worthy of health insurance agents’ consideration.

Complications of pregnancy and childbirth can create catastrophic claims. Eclampsia, for example, a condition that typically involves high blood pressure and metabolic changes, can lead to seizures, and strokes.

“Think of the cost of a stroke,” Segura said. “About $650,000 for one person.”

2. Health care providers are eager to make more use of remote monitoring services.

Segura said providers know from first-hand experience what can happen when providers miss signs that pregnant women are gaining weight too rapidly, or suffering from high blood pressure.

When patient monitoring fails, ‘the consequences are dire,” Segura said.

3. Getting paid by health insurers, and by employer-sponsored health plans, is hard.

He also tried persuading employers with self-funded plans to try the Babyscripts system, but he found they weren’t equipped to coordinate remote patient monitoring programs.

4. The new Medicare billing code is a start.

The Centers for Medicare and Medicaid Services recently announced that telehealth services can use a specific, stand-alone code, CPT Code 99091, to bill Medicare for up to $60 per month for telehealth services, such as remote patient monitoring.

Before, Medicare would only pay for telehealth services that provided live virtual visits that included both audio and video.

Segura has written in an op-ed about the new, unbundled billing code that it will create new opportunities for use of telehealth services.

One challenge, he wrote, is that the CMS decision for Medicare has no effect on Medicaid or on commercial plans.

Another, he wrote, is that the $60-per-month rate is low.

But “I think that’s a good start,” Segura said in the interview.

Segura said he thinks other payers will eventually come around, partly because many people know people affected by pregnancy complications.

5. For many types of health care in the United States, Medicare is the 900-pound gorilla. For pregnancy care, Medicaid is the gorilla.

Medicaid covers about 50% of U.S. pregnancies, Segura said.

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