“At the start of the pandemic, many providers and insurance companies removed subscriptions for visits because they wanted to encourage telehealth,” says Ellimoottil. “Now we have co-payments coming back from the major insurers. Ultimately, we don’t yet know what the net effect will be for patients, providers or payers.”
If telehealth increases appointments, for example, costs could rise. According to Ellimoottil’s research, the rate of secondary visits within 7 days is about 10% with an in-person visit. With telemedicine, the follow-up rate goes up slightly, which can lead to increased costs.
But, says Ellimoottil, costs are likely to come down.
“If a patient doesn’t have to pay for transportation, parking, or taking time off work to see a doctor, it could cost less than an inpatient visit,” he says. “But the question remains about how to calculate the appointments through telehealth.”
To understand telehealth billing, Ellimoottil says you have to understand the things used in personal care billing. “The same considerations apply,” he says.
- The time the appointment takes. “Over time, the bills are also being prepared,” he explains. “This has always been the case, even with personal visits.”
- The complexity of the appointment. “The official term here is ‘medical decision making,'” says Ellimoottil.
- The amount of data reviewed. “If the doctor is looking at the x-ray report versus the actual image, it’s less expensive,” he says. “Or if they have to prescribe a drug in exchange for sending a patient home with Tylenol, the cost goes up.”
In Heal’s case, then, the $80 telehealth bill may have come from the complexity of reading the CT scans and determining the next course of action, which the doctor then needs to explain to the patient.
“When I asked about the cost, they told me the doctor had spent 35 minutes preparing for the appointment, so it was billed as a full visit,” Heal says.
This goes back to the billing formula.
“Sometimes the appointment itself is short, but because the patient has an acute problem that requires tests or a prescription for antibiotics, the billing level is higher,” Ellimoottil explains.
But like Heal, many patients have trouble estimating how the cost of telehealth compares to an in-person visit. Is the quality of care equivalent? In some cases, yes, but many patients are skeptical about it, and thus the bills associated with it.