MESSAGE
| DATE | 2020-10-01 |
| FROM | Ruben Safir
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| SUBJECT | Subject: [Hangout - NYLXS] SNAFU with PBMs
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wsj.com
As Covid-19 Cases Rise, Insurers Reduce Coverage for Virtual Doctors’ Visits
Anna Wilde Mathews and Robbie Whelan
8-10 minutes
Major insurers are taking different approaches to covering remote care,
which is typically done by phone or video. The companies are offering an
array of deadlines, reimbursement strategies and charges, depending on
factors like the type of plan or the purpose of the medical visit.
Doctors and hospital officials say the complex rules are leading to
confusion—and the cost-sharing charges create concern that patients,
faced with an increased financial burden for telehealth, might delay or
avoid visits.
“It’s really very complicated,” said Ted Okon, executive director of the
Community Oncology Alliance. “It should be simplified and unified so
that you don’t have to constantly go back to this grid.”
The new Anthem and UnitedHealth changes, for instance, only apply to
certain plans and don’t include virtual visits related to Covid-19,
which will generally continue to be free for patients. Some other
insurers had ended cost-sharing waivers for telehealth visits earlier in
the year.
“Shifting the copayment back to patients now presents a risk that
patients will cancel telehealth appointments or seek in-person visits
that heighten the threat of infections,” said Thomas Owens, senior vice
president of Duke University Health System. Though many people with
insurance would be charged only a flat copay for virtual visits, others
might owe the full cost or a share of it, depending on their plan.
Telemedicine grew rapidly this spring and summer as the coronavirus
pandemic shut down swaths of the U.S. health-care system. Doctors and
hospitals around the country canceled much of their routine, in-person
care and patients stayed home, nervous about the risk of infection.
Insurers and the federal Medicare program rushed out expanded coverage
for virtual visits, often including reimbursement for doctors on-par
with what they previously received for seeing patients in their offices.
Consumer surveys by the Deloitte Center for Health Solutions, a research
unit of Deloitte LLP, found 28% of respondents this April said they had
used a virtual visit in 2020. At the start of the year, just 19% said
they had had one in the previous 12 months.
For Karen Smith, a family physician in Raeford, N.C., about a third of
her patient visits in a typical week is now virtual, she said. The
expanded coverage provided a financial lifeline to her practice and
enabled her to stay in touch with patients who were afraid to come to
the office because they feared viral infection, she said.
Patients might be less likely to use the remote visits if there is a
charge, Dr. Smith said: “If they do have to pay, our patients are not
going to accept the service.”
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continue to be covered by insurance? Join the conversation below.
Indeed, Linda Robertson, 71, who is Dr. Smith’s patient, says that
despite the convenience of telemedicine, a charge for digital visits
would mean she and her husband would do fewer of them. Ms. Robertson, a
retired teacher from Shannon, N.C. who has diabetes and rheumatoid
arthritis, is nervous about the risk of infection with the coronavirus.
With her current coverage, it is unlikely that Ms. Robertson would owe
copays for doctor visits, either virtual or in-person.
“I can’t afford to be paying copays every time I go to the hospital,”
Ms. Robertson said. “I don’t pay the copays, and if I did, I would
probably miss most of those meetings, I just couldn’t afford it.”
Phyllis Jacobsen, a retired health care claims processor, and her
husband Randall, a retired EMT, live in Raeford, and have had about a
half-dozen telehealth visits with Dr. Smith and some specialists this
year. Mr. Jacobsen, 61, had two strokes several years ago, resulting in
partial paralysis and loss of speech.
Ms. Jacobsen said telehealth has been a blessing because the strokes
compromised his immune system, making him more susceptible to
infections. She worries her husband might contract Covid-19 more easily
than others if exposed to it.
The couple is covered under a Medicare Advantage plan, but doesn’t hold
supplemental insurance. They typically pay copayments every time they
visit a doctor’s office. Since the pandemic began, however, telehealth
consultations have been free.
“His copays are not extravagant, but for us being on a fixed income,
even a $20 or $30 or $50 copay, that’s a lot of money for us,” Ms.
Jacobsen said.
Doctors and hospitals say they are also struggling with uncertainty
about future coverage of telehealth, since many insurers have said their
current policies are guaranteed only until the end of the year.
Christi Siedlecki, chief executive of Grants Pass Clinic, which provides
primary care in Grants Pass, Ore., said she is worried that the clinic
will lose telehealth payments when the federal public-health emergency
tied to the pandemic lapses, currently set to happen in late October.
“It’s not certain what the future holds,” she said. “Everything right
now is based on the state of emergency.”
UnitedHealth is tweaking its cost-sharing policy as “the health-care
system is returning to normal levels,” a spokesman said. The Oct. 1
change affects in-network non-Covid-19 visits for people with Medicare
Advantage and fully-insured employer and individual plans, the company said.
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newsletter once the crisis abates: Sign up here.
Anthem said that starting Oct. 1, patients enrolled in fully-insured
employer and individual plans will generally face cost-sharing for
non-Covid-19 virtual video visits with network providers. But telephone
visits—with no video—will remain free of charge at least until the end
of the year. The insurer’s Medicare Advantage enrollees will also have
no cost-sharing on video or phone visits at least until next year.
“As offices have been able to reopen, we have aligned our cost-sharing
for telehealth and in-person care for non-Covid cases,” an Anthem
spokesman said.
Other major national insurers are taking varying approaches. CVS Health
Corp.’s Aetna said it is waiving cost-sharing for virtual doctor visits,
both specialists and primary care, in its Medicare plans at least
through the end of the year. For those enrolled in fully-insured
employer plans, there are no out-of-pocket charges for virtual visits
for Covid-19 or behavioral and mental-health counseling. However, in
early June, the insurer restored cost-sharing for other types of
telehealth visits for those plans.
Cigna Corp. said it has waived cost-sharing for virtual visits related
to Covid-19 through the end of October for its commercial plans.
Out-of-pocket charges apply for telehealth not related to Covid-19, the
insurer said. Cost-sharing is still waived for virtual visits by
Medicare Advantage members, including those not for Covid-19.
Governments around the world are debating the timeline for offering
Covid-19 vaccines to the public, as drugmakers speed up development.
WSJ’s Daniela Hernandez explains the potential health risks linked to
fast-tracking vaccines. Photo: Siphiwe Sibeko/AP
Write to Anna Wilde Mathews at anna.mathews-at-wsj.com and Robbie Whelan at
robbie.whelan-at-wsj.com
--
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