When it comes to healthcare for our children, parents are on the front lines 24/7. Parents with special needs children are warriors. I am the mother of one of these warriors and a grandmother of an 8P hero. I have worked in the US benefits/healthcare field for 30+ years and continue to see challenges (and yes, frustrations) of dealing with insurance companies and navigating the complexities of benefits, what is covered, pre-authorizations, EOBs (Explanation of Benefits), choosing a health plan (and paying for it), nurse case managers, managing the bills and available services.
During this unprecedented time when we are protecting our families from COVID-19, we can’t access care the way we did a few months ago. Many doctors, therapists and medical offices are providing services remotely and we are experiencing most of our care via telemedicine. Telehealth services have been around for a few years and have made huge gains in popularity recently.
It is critical that parents become comfortable with and understand how to use telehealth services. Not only will this be of benefit in the short-term, but the benefits of understanding this system will help tremendously in the long term as well. All parents face time constraints with younger children still at home, however parents of special needs children especially so. By not having to physically show up to a health center or wait to see an over-booked doctor with limited time available, telehealth services give parents of special needs children more flexibility with scheduling, which can be a life-saver in and of itself!
What is telemedicine and telehealth? Telemedicine is when you receive medical care remotely via a video call or online. Pediatricians, PCP’s (Primary Care Physicians) and our regular specialists are conducting virtual visits from their homes or offices through online video services such as Zoom, Facetime or Skype. Some therapists are doing virtual visits but many are providing “homework” so parents are adding another role to an already full plate. Telehealth plans may offer alternatives for some types of care when getting appointments with your PCP is limited or unavailable. Telehealth plans provide office visits online with their own network of doctors via secure websites and apps for your smartphones and tablets. Some names of telehealth companies you may encounter are Teledoc, Doctor On Demand, American Well and MDLive but there are many more.
Does my health plan offer telehealth? Almost all health insurers like Blue Cross (MDLive, American Well), United Health (Teladoc, American Well, Doctor On Demand), Cigna, Aetna (Teledoc), and Anthem (LiveHealthonline) began adding telehealth services to their benefit plans a few years ago. Due to COVID-19, almost all insurance plans have added telehealth if they didn’t offer it already. To find out if your health insurance coverage includes a telehealth plan, you can check the carrier website or call the customer service number on your ID card.
What does telehealth cost for a visit? When you use telemedicine or virtual visits that are covered by your insurance, the cost and coverage is typically the same as if you had the services done in person. For telehealth plans your costs may be what you pay for an office visit such as your copay, deductible or coinsurance but may often cost you less. Many telehealth plans have lower copays and per-visit costs (helpful if you are on a high deductible plan). COVID19 testing and care are covered in full so you will have no cost for those visits. For general reference, samples of visit costs (before insurance) from Teledoc are: $75 per medical visit, $99 per mental health visit and $95 per dermatology visit. You can find the cost for your specific plan in your benefit summary, you can call the customer service number on your ID card or you can find costs when you provide your insurance information to the telehealth plan.
What can I use Telehealth for? Telehealth plans offer medical visits 24/7 from home for conditions like ear infections, sore throats, flu, pink eye, rashes and more. For parents of special needs children, this can be extremely helpful since pediatricians and family care doctors can call a prescription in to your local pharmacy. Things like topical creams, antibiotics etc. can be prescribed via visual diagnosis. By eliminating the in-person scheduling, the car ride to a health center, the parking and walking with a wheelchair, the entire process is much less of a hassle. In addition, some plans provide mental health visits, dermatology visits, nutritionists and assistance in finding specialists. No waiting to reach your PCP when their office is open means professional care without leaving home. By saving time and money, it’s a win-win all around.
How do I use telehealth? Check with your health care provider and then download their app or go to their website on your computer or phone. A lot of people have been asking for this service due to COVID-19 so your provider almost certainly has language on their website with easy to follow steps to set up your secure account. When looking into the process, it’s a good idea to have your insurance ID card and a payment method nearby and ready to reference. Also, if you have a Flexible Spending Account (FSA), Health Reimbursement Account (HRA) or Health Savings Account (HSA) debit card, you can use that to pay for your visits. After setup is complete, the process becomes routine. When you want to see a doctor, log in to your account and follow instructions to start a call/chat. Simple!
As an example, I’ll share with you my experience in setting this up for myself. My insurance plan offers Doctor On Demand. I followed the link sent to me by my provider, set up an account and now my login page shows things like visit costs, schedule times, etc. For my plan, medical Doctors and Psychologist virtual visits are $20.
At this point, let’s say I have a sore throat at 11 pm and want to reach out for healthcare service. At this time of night, my PCP is not available. However, through my Doctor On Demand app, I can login from my phone, start a visit, choose “first available doctor” and wait 3 minutes for a doctor to come online. From there, she reviews my symptoms with me and calls in a prescription to my local pharmacy which I can then pick up at the drive-thru when they open. I’ve spent $20, had immediate access to a family care doctor at 11 pm from the comfort of home and subsequently picked up my prescription. As you can see, the benefits to getting used to using this service are wide-ranging.
Below are some helpful links to some US national carrier sites to look up information on the telehealth services they offer. Keep in mind that each Blue Cross state plan and each employer may offer different telemedicine/telehealth services and providers – it will be specific to your plan so check the information on your medical ID card.
For Blue Cross and Blue Shield plans, you need to enter the state where your benefit plan is located.