Beginning Oct. 1, several insurers will no longer cover virtual visits in full under certain circumstances—a rollback of benefits that's sparked concern among providers and patients who've relied on telehealth amid the ongoing coronavirus epidemic.

Background

According to STAT News, many commercial insurers and government payers pivoted quickly to expand telehealth coverage when the epidemic first struck, with many for the first time offering to pay or reimburse for virtual visits at the same rate they did in-person visits. As a result, telemedicine use surged, especially among populations vulnerable to the novel coronavirus, including older adults and patients with ongoing medical conditions.  

However, as the epidemic continues, some of these telehealth benefits are set to expire—even as Congress, according to FierceHealthcare, looks to keep at least some of benefits in place once Covid-19 is over.

Some insurers to start rolling back telehealth extensions

For instance, according to STAT News, UnitedHealthcare on Oct. 1 will end its "virtual visit" benefit—originally extended to many members during the epidemic—that enabled members to have telehealth visits with in-network providers for non-Covid medical issues at no cost. However, the insurer will continue to make telehealth available at no-cost for members insured through Medicare Advantage (MA) and Medicaid for the rest of the year, FierceHealthcare reports. (The Daily Briefing is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group. UnitedHealth Group separately owns UnitedHealthcare.)

Similarly, Anthem on Oct. 1 is also ceasing waiving the cost of copays, coinsurance, and deductibles for non-Covid telehealth visits for commercially insured members, although it will continue to waive those costs for MA and Medicaid members until 2021. According to an Anthem spokesperson, as of Oct. 1, commercially insured members' "cost shares will be applied based on the terms of the plan they purchased."

Aetna adopted a similar approach earlier this year, ending its no-cost coverage of telehealth for non-Covid needs on June 4 for commercially insured members, while announcing it will retain that benefit for its MA members through the end of the year. (Aetna's roll back of the benefit for commercial members does have one exception, according to FierceHealthcare: No-cost virtual visits for outpatient behavioral care, as well as counseling, will be available across all of the insurer's plans until 2021.)

On the flipside, government payers appear inclined to retain current waivers, STAT News reports. CMS, for instance, has made its waivers permanent until Covid-19 is no longer a public health emergency and has already proposed codifying some of them.

What will access look like?

According to STAT News, it's unclear how much individuals affected by the changes will be expected to pay for virtual visits going forward, or how those potential costs may compare to the costs of an in-person visit.

However, patients who do learn of the costs before scheduling such a visit will likely face one of three scenarios, depending on costs, STAT News reports. A patient may decide to go through with the virtual visit, with the patient either paying any outstanding costs him or herself, or the hospital or clinic shouldering all or part of that cost; a patient may opt for an in-person visit; or a patient may choose to skip the appointment altogether. There's also the possibility—if the patient only learns after the fact that his or her visit wasn't covered—that he or she may "get hit with a surprise bill," STAT News reports.

Stakeholders express concerns

Several experts and physicians voiced concerns about the rollback, particularly regarding the potential confusion about what costs are or aren't covered, STAT News reports.

For instance, Ateev Mehrotra, a hospitalist and assistant professor at Harvard Medical School, who specializes in telemedicine research—said he was concerned with the ambiguity around what kinds of visits will be covered and to what extend they'll be covered, if at all. "What's been on my radar has been generally the uncertainty and constantly changing dates that the insurers have on their websites, which has just created a sense of uncertainty about where we're headed," he said.

Adam Licurse, executive director of the virtual care department at Brigham and Women's Hospital and Faulkner Hospital, echoed those concerns, noting that such ambiguity could burden small medical practices in particular, which either may not be able to help patients with their cost-sharing obligations or may lose a relied-upon stream of telehealth revenue. "To have a provider feel financial pressure to offer less telehealth and bring more patients into the office—because they have to pay the bills and keep the lights on and keep their practice running—is a pressure providers shouldn't have to face," he said.

And while Mehrota acknowledged that making telehealth coverage expansions permanent could lead to overuse by "mak[ing] care too convenient," he recommended that private insurers pledge to cover telehealth visits at the same rate as in-person visits for the duration of the Covid-19 public health emergency. At that point, "each insurer can choose whatever decision they want about telemedicine policy—we can have that debate now or later—but for now, I think we need that certainty" (Minemyer, Fierce Healthcare, 3/29; Robbins/Brodwin, STAT News, 9/29).