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Will you be reimbursed for your telehealth doctor's visits in Florida?


By John Haughey | The Center Square

With doctors’ offices among places to avoid in dodging COVID-19, proponents are lobbying Gov. Ron DeSantis and Florida health officials to promote telehealth as a way to get more people to see more physicians in virtual settings.

Among unresolved obstacles: disparities between reimbursements for telehealth services and those delivered in-person.

The Florida Medical Association (FMA) wants DeSantis to issue an emergency order mandating reimbursement parity for telehealth and in-person services.

“This action is needed in Florida given the uneven response of the health insurance companies doing business in this state,” FMA President Dr. Ronald Giffler wrote in a Thursday letter to DeSantis, state health officials and Florida Insurance Commissioner David Altmaier.

“Uniformity is desperately needed so that all health-care providers can comfortably provide telehealth services during the existence of the state of emergency without patients having to worry about their insurer denying coverage for such care,” Giffler wrote.

Florida Blue, the state’s largest private health insurer, has widened telehealth parity, but others, including United Healthcare, have not.

Florida Blue said Thursday its “primary care providers, behavioral health providers and specialists can bill for virtual visits if they have telemedicine capabilities and want to consult with their patients virtually.”

United Healthcare, which has 350,000 Florida members, announced Wednesday it was increasing access to telemedicine nationwide, but did not state if it would reimburse virtual services at same rates for in-office services.

Florida Association of Health Plans President and CEO Audrey Brown told The News Service of Florida that private health plans are “issuing guidance to their network providers promoting telemedicine and payment for services, as well as removing prior authorization for testing and treatment for the virus.”

Payment guidance varies by provider, however, creating the “uneven response” FMA wants DeSantis to level out by relaxing telehealth restrictions.

Executive action is “urgently needed to ensure all Floridians – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – have access to benefits that can keep them healthy while helping to contain the community spread of this virus,” Giffler wrote.

Florida is among the 10 states that don’t impose parity standards on private insurers and among the 20 without a telehealth insurance parity law.

According to the National Council of State Legislatures (NCSL), 40 states and Washington, D.C., impose some type of requirements on private payers to reimburse for telehealth services comparable to what they pay for in-person visits. Twelve states require full parity, the NCSL reports.

In 2019, Florida lawmakers adopted House Bill 23, which established standards of telehealth practice, but only required providers and insurers negotiate reimbursement rates.

The law, effective since July 1, states telehealth contracts “must be voluntary between the insurer and the provider and must establish mutually acceptable payment rates or payment methodologies for services provided through telehealth.”

There are three types of telehealth services: live video, store and forward (S&F) and remote patient monitoring (RPM).

Only six state Medicaid programs – Alaska, Arizona, Maryland, Minnesota, Virginia and Washington – reimburse for all three types. All state Medicaid programs, including Florida, reimburse for live-video services.

Florida is not among the 23 states with Medicaid programs that require reimbursement for S&F services, which includes consultations and sharing information, nor is it among the 27 states that mandate RPM reimbursement, according to the American Telemedicine Association (ATA).

DeSantis “has told Floridians to limit face-to-face contact with others as much as possible,” Giffler wrote. “We ask that you require the health insurance companies doing business in this state to do their part to help contain the spread of this acute public health danger and issue an order” enforcing payment parity.

Coronavirus, Health Insurance, Reimbursement, Telehealth, The Center Square, Virtual visit


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