Who Pays For Telehealth?

Jan 7, 2016

With just a few clicks of the mouse, Orlando mom Alyssa Grimes visits with a pediatrician from the comfort of her living room. She logs into a Skype-like application on her laptop, where she virtually meets her child's doctor based across town at Nemours Children's Hospital.

"Hi, I'm Dr. Vyas with Nemours..."

"This is Zack, and this is Zach's mom,” Grimes said. “My name's Alyssa.”

"What's going on today?" Vyas asked.

"Well, Zach woke up this morning not feeling too well today…”

After the virtual visit, Grimes said 5-year-old Zach was unfazed by the technology. He's grown up with it.

"Nowadays, that's how a lot of children connect with friends and family, through like a FaceTime,” Grimes said. “It was pretty similar to speaking to his grandma or grandma over FaceTime or Skype."

But this telehealth service  isn't covered by insurance. Patients must pay $49 per visit.

And that's where telemedicine gets tricky. There's no state law forbidding, restricting or regulating telehealth, so the biggest obstacle for patients and doctors is this: Who pays?

Nancy Wright, a a pediatric endocrinologist in Tallahassee, said 35 percent of her patients are in Georgia, where she's also licensed.

"Right now, I'm doing telemedicine out of my office in tall into Valdosta, a clinic there, a Children's Medical Services clinic,” Wright said.

Wright said her field is so specialized that many patients drive up to 100 miles to see her in person. The virtual space is a good option, but she said in order to see more Florida patients, she needs to get paid like she does in Georgia.

"It is financially sound for the office to do this,” Wright said. “We are paid for these visits by the children's insurance companies. In Georgia, there are only one or two insurance companies that refuse telemedicine. Everyone else is welcoming about this."

Christian Caballero, president of the Telehealth Association of Florida, said the group has proposed several ideas requiring insurance to cover a visit via telehealth. The group's first proposal was turned down. It required insurance companies to cover a visit via telehealth if it was covered face-to-face.

"Apparently, the insurance companies objected to it vehemently,” Caballero said. “They didn't want to be forced to provide this coverage."

A second proposal offering insurance companies corporate tax credits also failed to get support.

"That also has received some opposition from the insurance companies so they don't want to go with that either,” Caballero said.

Florida Rep. Cary Pigman, R-Sebring, is an emergency physician in rural Highlands and Hardee counties. He says he won't accept a plan that regulates telehealth in any way.

"You want to be careful when you get into proposing a bill to regulate something,” Pigman said. “Very often you then stifle any further development."

He said it may be better for the state to do nothing.

"If we do nothing, I think the business will continue to proliferate and unique products will be available,” Pigman said.

Grimes , the mother in Orlando, said while she doesn't mind paying cash for virtual visits, it'd be nice if there were more telehealth options covered by insurance.

But Pigman says he's doubtful lawmakers will have much to offer in terms of answers this coming session. 

--Daylina Miller is a reporter with WUSF in Tampa. WUSF is a partner with Health News Florida, which receives support from the Corporation for Public Broadcasting.