Question

1. There are many controversies regarding reimbursement for telemedicine services. Imagine that you are negotiating with an insurance carrier to obtain reimbursement for a store-and- forward telemedicine service that you have developed. The medical director of the second insurance payer states: “Telemedicine seems like ‘screening’ rather than a mechanism for delivering health care. This is because you are simply using technology to identify patients who need to be referred to a real doctor, rather than providing true medical care. Therefore we should only reimburse a very small amount for these screening services.” In your opinion, is this a legitimate argument? Explain.   

Answer 1

In your opinion, is this a legitimate argument? - NO

• The Insurance payer should reimburse the telemedicine services being used because that is considered to be a part of patient's treatment without which he cannot be refereed to a real doctor and this cost is paid from the patients pocket and is not free of cost. The Patients are using Telemedicine services so that they get to know the cause of their health issues and they can consult a doctor. So this becomes a part of patients treatment and whatever charges that are incurred on him, the patient pays from his own pocket. So he is paying for his medical bills which includes telemedicine service as well. So, the Insurance Payer needs to consider this point while re-imbursing the patient's funds.
• If the patient didnt go for Telemedicine services he wouldnt have known the cause of his health issues and as a result he cannot be referred to a real doctor. So this process is mandatory for him and cannot be skipped. If its mandatory then the patient will do it and charges will be incurred from him/her.
• The Insurance Payer should validate the documents of the patients first (what screening was done, why was it done, the date of screening and post medication steps taken) based on which the payer can decide whether or not to reimburse the medical cost. The Payer without having a look shouldnt disclose his judgement at the very beginning without having heard or seen the document proofs. For the patient initial diagnosis is very important in order to identify the root cause of his health hazards. If not done, can lead to serious health impacts and can damage his health seriously. So he needs to take Telemedicine services so that based on the reports generated he can consult a doctor for cure. Now this part of the expense cannot be neglected by the Insurance Payer.
• The Telemedicine services are authorized systems of healthcare and approved legally by medical institutions of the State. Hence it means that the system can be used as a part of Pre Phase Healthcare Delievery and charges paid if any are subject to re-imbursement as these devices have been opted by medicals for better treatment of patients. Thus the payer shouldnt neglect these facts when asked to reimburse by any patient. These systems are approved by legal State Authorities and are documented under laws and legislations so they cannot be termed as void or inconsiderate. The Insurance Payer needs to consider them while reimbursing patient.

Please let me know in case of any clarifications required. Thanks!