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What is Telemedicine?
There are many ways to receive medical treatment these days. Patients no longer only have the option of in-person visits. Now no matter where a patient is they are able to receive medical care. This is all done through telemedicine. Telemedicine is the practice of using technology to deliver care at a distance. Physicians are able to be in one location while patients are in another. Telehealth allows for addiction treatment to be received virtually. However, the same level of care and attention is still provided by medical professionals. Virtual appointments are very beneficial and they can save patients and medical professionals time and money.
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Telehealth and Addiction Treatment
Telehealth, on the other hand, refers broadly to electronic and telecommunications technologies and services used to provide care and services to patients at a distance. The term is more all-encompassing to all remote healthcare services. It includes services that are not specifically remote clinical services. However, telemedicine refers specifically to remote clinical services. It is important to understand the difference between the two when referring to remote medical services.
Patients have been able to receive remote medical services for quite sometime now. Many people have received care or treatment instructions from a medical professional over the phone. As early as the 1950s healthcare providers began offering remote services. Medical services could be done over landline telephones at the time. This allowed patients to be in the comfort of their homes and still receive treatment. Today remote medical services have expanded even more. Patients can now receive treatment from home, at their place of work, while traveling, and even in a dorm or hotel room. No matter where a patient is they are able to set up an appointment.
As technology continues to evolve there will be more options for virtual medical treatment. There are now apps to help medical professionals and patients manage virtual medical treatment. There are also online portals where patients can manage their medical history and set up appointments. Virtual care gives patients more control of their medical care options. Those in less populated areas have more access to different types of treatment options.
Medicare and Medicaid Coverage
Many people in the United States receive healthcare coverage through Medicare and Medicaid. If you or a loved one is covered under either of these programs it is important to know your options when it comes to telehealth services. What are these programs? Medicare is a program for individuals who are sixty-five and older or those who have disabilities. It’s a national health insurance program that is funded by the government from taxes. Most medical services are covered under Medicare. Medicaid, on the other hand, is insurance coverage for those who have limited resources and income. Medicare also covers most medical services including nursing home services and personal care services.
So are telehealth services covered under Medicare and Medicaid? The answer? Yes, if the services are considered medically necessary. It is important that individuals always check their individual insurance plans to know what is and isn’t covered. You will want to be sure that telehealth treatments are covered under the insurance that you use prior to seeking treatment. Otherwise, you may end up with some unpleasant expenses later on down the road. Always be sure to check with your insurance company and your individual policy.
The need for telehealth services is growing. Therefore, there are now more options when it comes to treatment and coverage. In March of 2020, the 1135 Waiver was introduced. This waiver allows Medicare to take care of costs for office, hospital, and other medical visits that occur via telehealth across the United States. This includes telehealth treatment that takes place at a patient’s place of residence. Providers ranging from doctors and nurses to social workers and psychologists are now able to provide telehealth services to their patients. The HHS Office of Inspector General is now also giving healthcare providers flexibility when it comes to reducing or waiving cost-sharing for telehealth visits that are paid for by federal healthcare programs such as Medicare. When it comes to Medicare and telemedicine coverage it is important to know what is covered prior to seeking out treatment.
Coverage for telehealth services when it comes to Medicaid is a little different than Medicare. To receive reimbursement for Medicaid services that are done via telemedicine there must be efficiency, economy, and quality of care. States have the final say when it comes to Medicaid and what is reimbursed.
The federal law is flexible and allows states to have the final say. States are encouraged to create innovative payment methods for services that incorporate telemedicine technology. States can decide to reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee at the original site. The choice to reimburse technical support, transmission charges, and equipment is also up to states. A state has complete flexibility when it comes to these decisions. As a patient it is important to know what is covered in your individual state. That way there are no surprises later on when it comes to telemedicine coverage and Medicaid.
Will Insurance Cover Telehealth Addiction Treatment?
Every insurance provider is different. It is important as a patient that you are aware of your insurance coverage and what is and is not covered under your policy. That way when you receive treatment there are no surprises when it comes to costs. There are five big insurance carriers in the United States. The big five insurance companies include United Healthcare, BCBS, Signa, Aetna, and Humana. All of these companies offer insurance coverage for telehealth services. However, telehealth services are policy-dependent so it depends on the policy you have with the insurance company.
Patients may or may not have coverage depending on their policy. For example, if a patient has a high-level plan such as a gold plan, coverage for telehealth services may be available. Plans that are lower-level plans such as bronze plans, may not provide coverage for telehealth services. In order to figure out if your own insurance plan covers telehealth services, you should call your specific insurance provider and ask about your policy. Make sure that you ask any questions you may have and address any of your concerns. It is also important to take notes. Write down a list of questions prior to your call. Questions such as:
- Does my policy cover telehealth services?
- What is the reference number for this call?
- Is there a specific billing code that needs to be used for telehealth services?
- Are there any restrictions on telehealth service when it comes to coverage?
- Do I need any special documentation from doctors for service?
Reference Your Call
These are all important things to know. Knowing the reference number for the call is also very important. That way if issues come up in the future you will be able to reference the call where the information you received was given. If a claim is denied and you were told by an agent that it would be covered you will be able to reference it. If the policy you have isn’t providing the type of coverage you need ask the agent for other options. They may be able to find a plan that fits your needs better and covers more of what you need.
Addiction Treatment with Telehealth
Telehealth services are beneficial for the majority of patients. However, is it beneficial when it comes to patients who are seeking substance abuse treatment? Studies have been done in order to see if there are benefits to telehealth substance abuse treatment. Fifty studies were done in order to see if there are benefits. Half of these studies were randomized controlled trials. The studies reported on the effect of telehealth addiction treatment and the patient’s substance use. The results of the study show that of the studies 61% of them fully supported telemedicine interventions. The interventions were successful and beneficial. 76% of the studies showed that participants in the studies were enthusiastic supporters of telemedicine. This shows that when patients try telemedicine services they usually have a positive experience and it is beneficial for their overall treatment. Most of the studies showed evidence of clinical effectiveness. Due to this more studies should be done in this field to see the effects of telehealth and addiction treatment.
The drug crisis in the United States continues to be on the rise. Substances such as opioids are continuing to be used across the country. Substance abuse disorders continue to affect communities and cities as a whole. It is important that treatment centers are effective and accessible to patients. Treatments need to be able to help those struggling with addiction. However, these treatments need to be available across the country no matter where an individual lives. When it comes to treatments such as mental health disorders and other chronic illnesses, telemedicine has been shown to be an effective way to deliver treatment. This is especially true with patients who have By doing treatment via telemedicine more patients are able to have access to treatment. No matter where an individual lives they are still able to receive the help they need. Individuals in rural communities tend to have less access to care. With telemedicine, they can receive treatment no matter where they are and they have more access to a range of treatments.
When it comes to medication-assisted treatment there are a limited amount of studies showing the benefits of telemedicine. However, a study was done on 177 patients in a rural drug treatment center that were treated with buprenorphine through telemedicine. The outcome of the study was pretty positive. Following one week of treatment, 98% of patients were substance-free. A month later 91% were substance-free. Two months later 73% were substance-free. After three months of treatment 86% of patients who remained in treatment tested negative for opioid in their system. This shows that the telemedicine delivery of treatment to patients worked. More studies should be done on telemedicine and substance abuse treatment. There are so many benefits for rural patients and the outcomes following treatment.
If you or a loved one is in need of substance abuse treatment but there are no treatment centers in your area, you may want to consider telemedicine services. Have questions or concerns? Give us a call at 815-384-1376.