This has been going on in Florida since last year.


"Will you be reimbursed for your telehealth doctor’s visits in Florida?
Denise ConnellMarch 21, 2020
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.

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.

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."

My televisits were for ongoing prescriptions required every 3 mos by the pharmacy. Now that restrictions are being lifted, my PCP has scheduled a physical visit in Sept for check-up, bloodwork, etc. Originally when the pandemic started my PCP's office mentioned that since my health was higher risk category that the televisits for certain meds would be allowed until further notice. And that is Sept in my case.

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Originally posted by just1tym:

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

That is funny. My wife is a health care provider and she can attest to the fact that there is absolutely no "negotiation" involved. None whatsoever. The insurers dictate reimbursement rates on a take it or leave it basis, and tell her that she is lucky to get what they give her. And then on top of that, they do audits and retroactively refuse payment for not complying with some protocol that they had never specified. Bastages.

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Originally posted by parabellum:
What's "telehealing"?

Do people just not see how ridiculous the world has become? Or, do they see it and just don't care to speak up?

ALL doctor's visits should be IN PERSON AND IN PERSON ONLY.

FFS!

Normally I would fully agrees but this was nothing more than a data entry visit. We had a 10 page questionnaire to fill out as a pre-assessment before the actual testing.
The Dr. asked the questions in the packet and did some follow up questions.
This Dr. was 2.5 hours away (one direction) so I am fine with a telehealth visit so I did not have to drive 5 hours to simply answer some questions.

Are there no telephones in your area? Sounds like a phone call was all that was needed. Let them try to charge you 1600 bucks for that.

It makes a bit more sense now. Doc is getting his $$ and a phone call just wouldn't cut it.

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Originally posted by V-Tail:

quote:

Originally posted by just1tym:

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

That is funny. My wife is a health care provider and she can attest to the fact that there is absolutely no "negotiation" involved. None whatsoever The insurers dictate reimbursement rates on a take it or leave it basis, and tell her that she is lucky to get what they give her. And then on top of that, they do audits and retroactively refuse payment for not complying with some protocol that they had never specified. Bastages.

V,initially the televisits started shortly after March when the pandemic first grew legs, my doctors office recommended doing the televisits because of my compromised health and condition. Normally I had to make an appointment with the Doc to get a written prescription required by Walgreens for this medication. Then shortly after Walgreens would accept the doctor calling my prescription in but limited it to every three months refills. My PCP office first charged the $45 for the televisit but as time furthered into the pandemic when I would call and ask if they wanted my CC number for the $45 charge, one girl didn't even know what I was talking about?? Eventually they didn't even charge me. The doctor is a friend of the family so he may have had something to do with no more charges, I really don't know, and didn't ask. I'm looking forwards to my first physical visit in Sept, things have been constantly undergoing change I never know what to expect when I called the Dr office

I have always wondered that if a hospital/doctor writes off that part of the bill unpaid, do they get to use this as an offset to taxes?

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Originally posted by ZSMICHAEL:

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Another interesting question is what is the Medicare and Medicaid rate?

^^^^^^^^^^^^^^
These rates are set by the Government, and are a fraction of what private insurance will pay. Collection involves a complex process with pitfalls. Most independent physicians do not deal with Medicaid and try not to deal with Medicare. It is a matter of economics.

I would guess about $175. The days of rich physicians is long gone. There are still a few guys who are senior partners in lucrative group practices that make big bucks, but a solo practitioner does not rake in tons of money. There is a shit load of over head that demands to be paid and a bunch of payers that insist on paying bottom dollar for their insureds.

If I were 20 something (HA!) never again.

RMD

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I have always wondered that if a hospital/doctor writes off that part of the bill unpaid, do they get to use this as an offset to taxes?

Most people don't understand how write offs work. You only pay taxes on income. If the bill isn't paid, that income isn't received, and you're not paying taxes on that non existent income. Unpaid bills do not offset taxes.

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I have always wondered that if a hospital/doctor writes off that part of the bill unpaid, do they get to use this as an offset to taxes?

^^^^^^^^^^^^^^^^^^^
As far as doctors are concerned the answer is NO. To add to this if a patient fails to pay their portion of the bill you cannot write if off on your taxes.