Pa. legislators say it’s time to require insurers to pay for virtual health care

In Pennsylvania, private insurance companies don’t have to pay for patients’ virtual checkups with their own physician, or cover any health care services provided without an in-person visit.

The state is one of just seven that doesn’t require insurers to cover telehealth, according to the National Consortium of Telehealth Resource Centers, a collection of national and regional resource groups focused on expanding access to telehealth.

Twice before the pandemic, and once during, the state General Assembly failed to pass bills requiring private insurers to cover virtual care. Now, after three years of widespread telemedicine use during the pandemic, and a new Democrat majority in the House, legislators are hopeful.

“Telemedicine is too convenient and too effective to ignore as a tool at this point,” said State Rep. Michael Schlossberg, an Allentown Democrat who has advocated for telehealth for mental health care.

Republican State Sen. Elder Vogel (R., Allegheny) sponsored bills in 2016, 2018, and 2021 requiring private insurers to pay for telehealth services. A new draft is now circulating, and he expects to introduce it in the coming weeks.

“The pandemic hit, and we realized how important this really was,” Vogel said.

» READ MORE: Lack of telehealth law in Pennsylvania a major headache for patients who need it most

When a patient and a health care provider interact by live video or consult by phone, that’s telemedicine, said Kathy Hsu Wibberly, director of the Mid-Atlantic Telehealth Resource Center, one of the regional centers participating in the national coalition. It can also include remote monitoring of health conditions.

Most insurers already provide comprehensive telehealth coverage, said Jonathan Greer, president of the Insurance Federation of Pennsylvania, a state trade organization.

“We do not oppose any legislative involvement in this, so long as it doesn’t interfere with what we’re doing now and doesn’t unintentionally impede its growth in the future,” Greer said.

Over the last three years, the pandemic made virtual visits routine. Nationally, 28% of Medicare recipients had at least one telehealth visit in 2021, compared with 1% in 2019.

Before COVID, doctors with Jefferson Health conducted roughly 50 telemedicine appointments daily. That skyrocketed to 3,000 daily at the peak of the pandemic.

Today, virtual visits still are happening at least three times more often than occurred pre-pandemic, said Judd Hollander, an emergency care physician who started and runs the hospital telehealth portal, JeffConnect.

“If your readers think about the number of times they went to their doctor but [their doctor] didn’t really touch them, those are great things to use telemedicine for,” Hollander said.

Most commercial insurers voluntarily covered telemedicine for much of the pandemic, recognizing that some patients feared exposure to COVID and wanted to avoid in-person appointments, health care providers said. Other states have reported insurers scaling back reimbursements, said Kate Slatt, vice president of innovative payment and care delivery with the Hospital and Healthsystem Association of Pennsylvania, and the lack of legal guidelines from Harrisburg means the same could happen here.

“What we’re seeing nationwide and in other states is payers pulling back on that reimbursement they provided,” Slatt said.

Without legislative action, insurers could be selective about what types of telemedicine visits they will pay for, or make telemedicine appointments available only though certain doctors, rather than a patient’s regular physician.

“It really is unfortunately a big unknown at this point, or it’s extremely variable,” said Shari Erickson, chief advocacy officer for the American College of Physicians.

Still, Pennsylvania’s insurance trade group says there are times when telemedicine isn’t appropriate. Greer cited as an example a dermatologist who doesn’t have a video camera with the quality levels needed to properly diagnose a concerning blemish.

“There may be a very good reason why we impose certain conditions on certain providers and certain procedures,” Greer said.

People relying on Medicare and Medicaid, the government’s insurance programs for seniors and low-income households, aren’t affected by the private insurance debate, experts noted. Medicare will reimburse recipients for telehealth service for behavioral and mental health care indefinitely, and for other medical services through the end of 2024. State rules allows Medicaid to pay for telehealth visits when clinically appropriate, according to the state Department of Human Services.

The national COVID-19 emergency declarations are due to expire May 11, which has spurred conversation about telehealth access, though they never required insurers to cover telehealth.

The six other states that don’t require insurers to cover telehealth are Alabama, Idaho, North Carolina, South Carolina, Wisconsin and Wyoming.

» READ MORE: What does the end of the pandemic public health emergency mean for you

Access to telehealth has meant fewer skipped appointments for mental health care, said Christine Michaels, executive director of the National Alliance on Mental Illness Keystone Pennsylvania, a state chapter of the mental health advocacy nonprofit. Many patients valued how it allowed for greater privacy.

“It got people into treatment that might not have gone because they didn’t want to go into a clinic or they didn’t want to be seen going to a psychiatrist’s office,” she said.

Telehealth also expanded access to medical care outside of bigger cities. As a lawmaker representing rural Pennsylvania, Vogel said people in his district may have to drive more than an hour round trip for follow-up appointments in Pittsburgh hospitals.

Vogel’s past efforts to pass legislation guaranteeing coverage for telehealth services got blocked when House Republicans raised concerns about telemedicine visits being used to prescribe abortion-inducing drugs. With Democrats now controlling the House by a slim majority, many believe Senate Republicans will not be an obstacle to changing the law.

“The framework was already there,” said State Rep. Dan Miller, a Pittsburgh Democrat. “We don’t need four months to decide really how to do it.”