One of the biggest healthcare issues we face in the U.S. is the exorbitant cost of providing care. In 2019, we spent $3.8 trillion on healthcare. That is mind blowing. It amounts to almost $12,000 per person or 17.7% of our Gross Domestic Product (GDP).
That’s a lot of Bitcoin. Of that nearly $4 trillion, 11% or $406 billion was paid directly out of our pockets. Commercial and government payers (insurance companies) covered the difference, but at what cost to us?
The average cost of health care premiums has been rising steadily for years. As of 2018, premiums were approaching $20,000 per family. We are all spending WAY TOO MUCH on healthcare to be as unhealthy as we are as a country.
Now enters telemedicine into the equation. Virtual house calls from the comfort of your home. But how much does telemedicine cost? Is telemedicine reimbursed by insurance? Is telemedicine less expensive than in-person care or are we just adding to this ballooning problem of healthcare spending?
Fear not, we’re here to help. Let’s examine the costs of telemedicine and see if it’s a cost effective solution. Since new telemedicine companies are popping up each day, we’ll examine some of the more popular options as of 2021.
During the pandemic, insurance coverage for telemedicine is changing by the day. We’ll try to summarize the latest information available. As always, it’s a good idea for you to check with your specific insurance plan to confirm whether telemedicine visits are covered.
Telemedicine Cost – Independent Companies
Teladoc – $75 and up
The most well known telemedicine company is Teladoc. Although most patients utilizing their services are covered through insurance, Teladoc does offer primary care, dermatology and specialty services for cash fees.
Telemedicine costs start at $75 for general medical visits, but unfortunately, they don’t list the price of their other services without creating an account. More price transparency would be great in healthcare. Consumers deserve to know the cost of telemedicine services.
Amwell – $79
One of the other big players in the urgent care telemedicine space is Amwell. Similar to Teladoc, this telemedicine service is best used for non-serious urgent medical conditions such as colds, allergies, and UTIs.
The cost of a telemedicine visit is $79 outside of insurance. As they state on their website, this compares favorably to the “average national cost of $139 for an office visit or $645 for an emergency room visit.”
It’s important to know that they don’t order lab tests nor provide ongoing care. They also state that most visits take 10 minutes but “of course, you can add more time should you need to.” I sure hope this doesn’t mean there’s a timer that’s counting down during the visit. I remember having to add quarters to payphones. I don’t want to do this again.
PlushCare – $119+
“Virtual primary care and mental health treatment when you need it.” This sums up PlushCare perfectly. They offer urgent and ongoing care with a membership model.
An initial telemedicine visit costs $119 outside of insurance. You then are charged a membership fee of $14.99 per month or $99 per year which provides you with:
- Unlimited in-app messaging
- Online care team
- Online same day appointment booking
It is not clear on their website if follow up telemedicine visits also cost $119 or if these visits are included in their membership model.
GoodRx Care -$19-$49
GoodRx began as a company which helps consumers compare prescription drug costs at different pharmacies. In 2019 they acquired HeyDoctor and began offering telemedicine services under GoodRx Care.
They cover common medical ailments that typically require testing or prescriptions. If you need a quick prescription then this seems like a great option for a cost of $49 for non-members and $19 for members of their Gold membership ($5.99 a month).
At the moment they don’t appear to offer specialist or in-depth telemedicine services.
Doctor On Demand – $75+
And the mergers continue. In 2021 Doctors On Demand merged with Grand Rounds Health to form Included Health. Doctors on Demand is the telemedicine entity which offers:
- Urgent care
- Behavioral health
- Preventative health
- Chronic care
The “urgent care” telemedicine visits with a board certified clinician cost $75 for a general practitioner. They can treat: cold/flu, allergies, headaches, men’s health and women’s health. I guess getting a prescription for Viagra is “urgent” according to men LOL.
The telemedicine cost increases to $299 for a 45 minute consultation with a psychiatrist. Behavioral health services require in-depth evaluations with mental health experts thus the higher pricier tag.
SteadyMD – $99 a month
For those looking for more than a one-night stand with a doctor, SteadyMD might be your answer. SteadyMD offers a primary care membership model for a telemedicine cost of $99 per month. You are matched with a physician who best suits your needs. Then, you have unlimited access via text and telemedicine visits with no additional fees.
I’m a big fan of their model because they provide access, price transparency and continuity of care. They even appear to provide preventative medicine. Sadly, it’s rare that a doctor will discuss your diet and exercise habits in depth despite how important these are to your health.
Their roster of primary care doctors includes such badasses who’ve squatted 500 lbs, run a marathon in under 3 hours and completed an IronMan triathlon. These doctors practice what they preach. Kudos to SteadyMD!
LiveHealth Online – $59
LiveHealth joins the long list of primary and mental healthcare telemedicine options. A telemedicine visit costs $59 for primary care visits. Psychiatry evaluations start at $175.
They will write short-term prescriptions or refills for existing medications. But, if you’re looking for on-going, more complex care then you should look elsewhere.
MDLIVE – $82
If you need urgent care, behavioral health or help with a skin condition, then MDLIVE might be an option for you. Depending on your insurance plan, your visit may be covered for free. Otherwise telemedicine costs are:
- Urgent care: $82
- Behavioural therapy: $108
- Dermatology: $95
HealthTap – $80
HealthTap is a primary care telemedicine service which provides urgent and chronic illness management. Their unique selling point is providing the customer with online resources to answer medical questions themselves. HealthTap accomplishes this with an extensive online library and artificial intelligence (AI) symptom checker.
Telemedicine visits without insurance cost $80. If you choose their Prime membership program, you won’t get your groceries delivered, but you will have discounted visits at $39. Prime members also are able to maintain an ongoing relationship with their same doctor.
Rethink My Healthcare – $24.99+
Rethink My Healthcare offers primary and mental health care for the entire family. When you sign up, you decide on a one-time visit for $24.99 or a monthly membership for $99 a month. With a monthly membership, you will not have co-pays.
It appears that there used to be an affiliation with MDLIVE (see above) but there continues to be mention of MDLIVE when researching their virtual medical services. Also, this service is not meant to replace your primary care doctor. So unless you get frequent illnesses or injuries, and have an inaccessible primary care doctor, I’m not certain why you’d want to have a monthly urgent care membership.
hims – Free
There’s always a catch when the cost of something is $0. Hims is one of the more popular men’s health clinics. Their business is centered on getting you prescription medications discreetly, quickly and on a recurring basis.
They are offering a “free” telemedicine visit for erectile dysfunction with the hope that you’ll order your Viagra or Cialis through their service. Their medication prices appear to be comparable to other discount online pharmacies.
Hims also offers primary care visits for infections, allergies and skin conditions. These telemedicine visits cost $39. The doctors can also send prescriptions to your local pharmacy if the medication is not offered by hims.
There is also a telemedicine platform for women cleverly named hers offering female-centric services.
Roman – free
This company has stormed onto the scene as the leader in digital men’s health (vanity) care. If you need medication for your penis, hair or skin, then Roman is your new bro. Visits are “free” because they are really about selling you medications.
It’s not clear how much medical care is actually occurring beyond shipping medications to your home. As long as you’re cool with that, then have at it hoss.
Their sister brand Rory is now offering a female-centric line of medications.
Lemonaid Health – $25
When life gives you lemons . . . there’s Lemonaid Health. Lemonaid is your drink of choice (the puns are too easy and tempting) if you need quick basic medical care. They have partnerships with labs to order blood tests. Medication prescriptions can be sent to your local pharmacy.
For simple one-time visits that are problem focused, the cost is a very affordable $25. For more general medical visits, the telemedicine cost is $75 per visit. Be certain to check out their website for medical situations they will NOT treat via telemedicine. Some conditions require an in-person evaluation.
Maven – ?
Maven is one of the standouts in the specialty telemedicine space. They are centered around women’s health, but also provide care for all members of young families. Infertility evaluations, pregnancy, and postpartum issues are some of Maven’s digital services.
OB/GYNs, lactation consultants and pediatricians are there to support aspiring or new moms. They center around forming partnerships with employers to offer free services to women. It’s unclear upon researching their site, how much a telemedicine visit costs otherwise.
VirtuCare – $89
We believe in delivering expert health care. When you have trouble in the bedroom or the bathroom, don’t settle for any provider, call in the expert. A urologist is a specialist of the urinary tract and male genitals.
VirtuCare offers initial consultations at $89. These visits average 15 minutes for most common urological problems. We can also offer more in-depth second opinions up to 30 minutes for $139.
Unlike other telemedicine services, we provide specialists who can provide in-depth medical care. Our specialists are not incentivized to sell you medications either. When we’ve reached the limit as to what can be treated via telemedicine, we will even provide a warm handoff to a colleague for in-person care.
Considering that 60% of U.S. counties don’t have a practicing urologist and the U.S. is predicted to have a shortage of several thousand urologists in the next 5-10 years, access to urology services is quite limited. $89 is a bargain to visit with a board-certified specialist from the comfort of your home.
By the time you read this, hopefully we will have achieved our goal of expanding into other specialty services.
Telemedicine Reimbursement – Insurance Companies
Reimbursement of telemedicine services by payors (aka insurance companies and the government) is all over the place. Before you assume your telemedicine visit is reimbursed, be certain to contact your medical insurance company. Blue Cross Blue Shield (BCBS) in Tennessee may provide different coverage than in Illinois. Even within the same state, insurance companies offer unique plans that vary from person to person.
We will try to summarize the current available information for each of the major insurance companies. This is a very fluid situation especially during COVID. Our hope is that the pandemic will open the door for universal reimbursement of all telemedicine services.
The good news is at the moment 37 states have laws mandating that telemedicine is reimbursed on par with in-person healthcare services.
Medicare Telemedicine Reimbursement
Prior to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) provided reimbursement for a limited number of telemedicine services. In March 2020, the federal government waived these restrictions on telemedicine reimbursement to allow for the continued delivery of healthcare services. This includes new patient visits regardless of geography.
The lifting of these restrictions on telemedicine reimbursement was renewed in April 2021. Coverage beyond 2021 is uncertain at this time, but the news out of D.C. is favorable for continuing telemedicine reimbursement. Further good news is that your out-of-pocket responsibility for telemedicine services is no different than for in-person visits.
Remember that if you have a Medicare Advantage (MA) plan, you should contact your specific plan for telemedicine reimbursement details. Luckily 98% of MA plans, provide some sort of telemedicine coverage.
Blue Cross Blue Shield Telemedicine Reimbursement
1 out of 3 U.S. citizens receive healthcare coverage by Blue Cross Blue Shield. In March 2020 at the start of the pandemic, BCBS announced that they would reimburse for all in-network telemedicine services across their 36 independent entities. The good news is that as a general rule, BCBS has been at the forefront of continuing to provide telemedicine reimbursement.
The Federal Employee Program (FEP) with BCBS has partnered with Teladoc to provide discounted or free co-pays for telemedicine visits.
As of April 2021, several state BCBS companies have permanently extended telemedicine reimbursement including Tennessee, Texas and the FEP.
United Healthcare Telemedicine Reimbursement
In January 2021, United Healthcare (UHC) announced that they will “reimburse appropriate claims for telehealth services in accordance with the member’s benefit plan.” In other words, call UHC to make certain your telemedicine visit will be reimbursed. The visits must be via a live audio-visual platform. Old fashioned phone calls don’t count.
Humana Telemedicine Reimbursement
Humana has decided to follow the latest CMS (aka Medicare) and state-specific telemedicine regulations during the public health emergency (PHE). Unlike UHC, Humana reimburses telephone calls for those patients without access to secure video software. New patient visits via telemedicine will be reimbursed at the same rate as in-person visits.
Cigna Telemedicine Reimbursement
Cigna also released a statement in January 2021 with their updated telemedicine reimbursement guidelines. As long as the visits are via an audio-visual, secure platform, then telemedicine reimbursement will be the same as in-person visits.
Physicians should be aware of their specific telemedicine reimbursement rules, otherwise your claim will be denied or paid at a reduced rate. At the moment, Cigna is not committing to continued reimbursement of telemedicine services after PHE, but instead will follow the lead of CMS and other commercial payers.
Aetna Telemedicine Reimbursement
Aetna recommends that you login to your Aetna member website to confirm telemedicine coverage. In general, their telemedicine policy states telemedicine reimbursement similar to face-to-face visits as long as it’s via an audio-visual interactive platform.
Aetna also appears to have a number of partnerships with Minute Clinic, Teladoc and MD Live, if your regular doctor or specialist is not available for a telemedicine visit (shame on them!).
Anthem Telemedicine Reimbursement
Just give them a call LOL. I honestly got a headache trying to find any telemedicine policies for Anthem. Their telemedicine reimbursement appears to be state-specific and in-line with most other insurers. I hope you receive a clearer answer than I did from Dr. Google.
Medicaid Telemedicine Reimbursement
Lack of clarity continues with Medicaid telemedicine reimbursement. Medicaid varies from state to state and should be viewed as 50 separate entities. The good news is that most state Medicaid programs have lifted many of the telemedicine restrictions during COVID including providing equal telemedicine reimbursement to in-person visits.
Conclusions – Telemedicine Cost and Reimbursement
Boy was that a whirlwind of numbers and policies. One thing is clear to me, the financial side of U.S. healthcare is a hot mess. Lack of transparency with costs and policies causes pain to doctors and patients alike.
Join me in the fight by supporting telemedicine companies like VirtuCare who aim to provide affordable expert healthcare with no hidden fees. We are proud to support other direct pay telemedicine providers such as:
- Rheumatology: Dr. Diana Girnita (https://rheumatologistoncall.com)
- Orthopedics: Moonlight Ortho (https://moonlightortho.com/)
- Dermatology: Cortina Health (https://www.getcortina.com/)