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Health care providers, insurers at odds over payment of telehealth services

The Pennsylvania Department of State issued a COVID-19 waiver that authorizes the use of telemedicine, but that waiver expires in March.

HARRISBURG, Pa. — The use of telehealth has surged since the start of the pandemic. Specialists and other health care providers are able to expand their reach to patients. Many Pennsylvanians have come to rely on phone and video appointments with their doctors. 

Telehealth services have increased healthcare access to populations in rural and urban areas alike.  It has eliminated what could have been a rural patient's two-hour drive round-trip for a 10-minute office visit. However, it still presents a digital divide among patients who do not have access to reliable internet connections.  

“With omicron and some of the COVID aspects still lingering people feel a lot more comfortable in their home, especially for behavioral health, instead of going to a doctor’s office,” said Dr. Michael Seavers, Associate Professor of Healthcare Informatics at the Harrisburg University of Science and Technology.

There is one problem. Pennsylvania has no state law mandating or banning the use of telemedicine. Health care providers are allowed to practice it, but insurance companies are not required to cover it. Despite this, insurance companies in Pennsylvania have continued to pay for telehealth services during the coronavirus pandemic and there is no indication they will stop in the middle of a health crisis.

Without clear regulations, though, insurers are at odds with providers over payments for these visits. Insurance companies argue that in-person office visits should not cost the same as telehealth consultations.

“The insurance side of the fence is saying, ‘Hey look, for telemedicine, you the provider don’t have to pay for an office. You don’t have to pay for the equipment.’ That’s the argument that telemedicine office visits should be lower,” Dr. Seavers explained. “The providers on the other hand say, ‘Look, we agree with you on that aspect, but now we need IT infrastructure which we didn’t have to have before.”

Some insurance companies have created their own contracting firm and direct patients to their telemedicine providers in order to save on costs. The Pennsylvania Department of State issued a COVID-19 waiver that authorizes licensed health care providers to use telemedicine during the coronavirus pandemic, but that waiver expires in March.

Senator Elder Vogel—a republican who represents parts of Beaver, Butler and Lawrence counties—has been trying to pass legislation that would make telehealth permanent in the Commonwealth. 

The proposed bill defines telemedicine, offers guidelines outlining who can provide telemedicine services, and provides clarity around insurance company reimbursement for these services. It passed in the state Senate last year, but is being held up in the House Insurance Committee. 

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