Chethan Sarabu, MD
Nov 15, 2024
Imagine this: You’re feeling under the weather and decide to book a telehealth visit instead of waiting days for an in-person appointment. You speak to a doctor for 15 minutes, get a prescription, and feel grateful for the convenience. Weeks later, you receive a bill for not just the consultation fee but a separate $100 facility charge—even though you never set foot in a clinic. Unfortunately, stories like this are all too common, and they highlight the need to understand how telehealth is billed. Understanding how telehealth visits are billed can help you avoid surprises and make informed decisions about your care.
What Determines Telehealth Costs?
The cost of a telehealth visit can vary based on several factors, including the type of provider, the services rendered, and your insurance coverage. Here’s what to consider:
Provider Type
In-network telehealth providers usually cost less than out-of-network ones. If you’re using a telehealth platform, double-check whether the provider is covered under your insurance plan.
Service Type
Not all telehealth visits are billed the same way. A quick consultation for a minor ailment may cost less than a specialized service, like mental health therapy or chronic disease management.
State and Insurer Rules
Many states have telehealth parity laws requiring insurers to cover virtual visits the same way they would in-person visits. For example, states like California and New York mandate parity for telehealth services, ensuring patients aren’t charged extra simply because the visit was virtual. However, these rules can vary and not all insurers fully comply.
Common Telehealth Billing Issues
Even with telehealth’s benefits, billing surprises are not uncommon. Here are some issues to watch for:
Facility Fees
Some hospital-affiliated providers charge facility fees for telehealth visits, even though you’re not stepping foot in their building.
Example: A patient schedules a virtual follow-up with a hospital’s primary care doctor. Along with the $50 consultation fee, the bill includes a $150 facility fee, typically used for in-person visits.
Out-of-Network Charges
If you’re using a telehealth service outside your insurer’s network, you might face higher out-of-pocket costs. Many patients assume telehealth platforms are fully covered but later discover otherwise.
Example: A patient uses a popular telehealth app for a dermatology consultation, only to receive a $300 bill because the platform’s providers weren’t in-network.
Lack of Price Transparency
Telehealth platforms don’t always provide upfront pricing. Without clarity on costs, patients can end up with bills higher than expected.
Example: A mental health session on a telehealth app is advertised as $75. After the session, the patient receives a bill for an additional $100 “processing fee” that wasn’t disclosed during booking.
How to Avoid Telehealth Billing Surprises
Here are steps you can take to protect yourself from unexpected telehealth costs:
Verify Coverage
Before your appointment, check with your insurer to confirm whether the provider and service are covered and what your out-of-pocket costs will be.
Ask About Pricing
Contact the telehealth platform or provider directly to ask about the cost of the visit, including any potential fees or additional charges.
Know Your State Laws
Research your state’s telehealth parity laws to ensure your insurer is billing fairly. Research your state’s telehealth parity laws to ensure your insurer is billing fairly. States like California, New York, and Illinois have strong parity laws that protect patients, while others, like Alabama and South Dakota, offer limited protections. Knowing your state’s laws can help you anticipate and challenge unfair charges.
Request an Itemized Bill
If you receive a telehealth bill that seems high or unclear, request an itemized breakdown. This can help you spot errors or fees you weren’t informed about.
The Future of Telehealth Billing
As telehealth continues to grow, billing practices are evolving. Many telehealth platforms and providers are working toward greater transparency, offering clearer pricing structures upfront. Additionally, regulatory efforts may further standardize telehealth billing to ensure fairness and consistency for patients.
The No Surprises Act offers additional protections, particularly for emergency telehealth services. Under this law, out-of-network providers cannot charge surprise fees for telehealth visits that occur in emergency contexts, ensuring more predictable costs for patients.
Telehealth offers unparalleled convenience, but understanding how it’s billed is essential to avoid unnecessary costs. By verifying coverage, asking about pricing, and staying informed about your rights, you can take control of your telehealth experience and enjoy the benefits of virtual care without the financial surprises.