Insurance Reimbursement Affects Student Use of Telemedicine

One longstanding barrier to wider telemedicine adoption is reimbursement: Medicare, Medicaid, and private insurance each have complex guidelines about which providers, patients and applications qualify. Those caveats make it tough to develop a telemedicine offering capable of covering its costs and benefitting as many patients as possible.

Take the example of college students who wake up sick in their dorm room, Greek house, or apartment. If they feel up to it, they can trek to the student health center, spreading whatever they have along the way.

But most college students now have a laptop, tablet or smartphone running Skype, FaceTime, or another two-way video service. So wouldn’t it make more sense for them to stay home and see if they can get a remote diagnosis? Maybe, but depending on where they’re going to school, they could wind up having to pay for that convenience.

“The type of telehealth that would take place where the student is in their apartment or dorm is not currently reimbursable,” says Rachel Mutrux, Missouri Telehealth Network senior program director. “The student would have to pay out of pocket.”

Now suppose the student has a condition that doesn’t make it a chore to visit the campus health center. If there isn’t a doctor on site who can treat that condition, the facility could use videoconferencing to bring in a specialist.

“Providers can get paid when the student is in the student health center and sees a specialty care provider over telehealth,” Mutrux says.

The facility-based requirement also affects telemedicine outside of colleges and universities. For example, the Missouri legislature is considering a bill that would have Medicaid reimburse health care providers that use videoconferencing to serve K-12 students at their schools, such as the nurse’s office. The bill’s sponsor, Rep.-elect Kip Kendrick, says 18 other states have implemented similar legislation.