Which insurance companies, such as UnitedHealthcare (UHC), Anthem, Aetna, Cigna, and Humana, cover telehealth office visits?

Insurance Coverage for Telehealth Office Visits

Many major insurance companies now cover telehealth office visits, including UnitedHealthcare, Anthem, Aetna, Cigna, and Humana, though coverage policies vary by state, plan type, and are subject to ongoing regulatory changes. 1

Current Coverage Landscape

Private Insurance Coverage

• 21 states and the District of Columbia require private insurance plans to cover telehealth services 2
• Major private insurers that have expanded telehealth coverage include:
  • UnitedHealthcare
  • Anthem
  • Aetna
  • Cigna
  • Humana

Coverage Variations and Limitations

• Coverage policies differ significantly between insurers and even between different plans from the same insurer
• Many private insurers have partnered with telemedicine companies to provide remote consultation services 2
• Some insurers reimburse telehealth visits at the same rate as in-person visits (telehealth parity), while others may reimburse at lower rates 2

Types of Telehealth Services Covered

Most major insurers cover the following telehealth services:

• Office or outpatient visits (new and established patients)
• Consultations
• Individual psychotherapy
• Pharmacologic management
• Behavioral health services 2

Factors Affecting Coverage

Geographic Considerations

• Urban health centers are more likely to provide >30% of healthcare visits via telehealth compared to rural centers 3
• Patients in areas with low broadband access are 7.2% less likely to use video visits compared to audio-only visits 4

Patient Demographics

Patient characteristics that affect telehealth utilization include:

• Age (older patients less likely to use video visits)
• Race (African-American patients 10.2% less likely to use video visits)
• Language needs (patients requiring interpreters 19.3% less likely to use video visits)
• Insurance type (Medicaid patients 12.1% less likely to use video visits) 4

Recent Regulatory Changes

• During the COVID-19 pandemic, CMS and private insurers expanded telehealth coverage dramatically 5
• Many emergency waivers were implemented in 2020, including:
  • Removal of location restrictions
  • Full provider reimbursement for telehealth visits
  • Coverage for more medical specialties and practitioner types 5
• Many of these expanded coverages may change as pandemic-related emergency provisions expire

Documentation Requirements for Reimbursement

For proper reimbursement, providers should document:

• Patient consent to telemedicine
• Method of telemedicine (secure video connection or phone call)
• Patient location
• Provider location
• Clinical participants' roles
• Other individuals present at the visit 2

Potential Future Changes

• Nearly 64 million Medicare patients risk losing most telehealth access as pandemic emergency provisions expire 5
• Post-pandemic policies that eliminate coverage for audio-only visits may disproportionately affect vulnerable populations 4
• Research suggests telehealth visits may substitute rather than add to in-person care, potentially reducing costs for insurers 6

Practical Considerations for Providers

• Verify patient insurance coverage for telehealth before scheduling
• Be aware that reimbursement for audio-only visits varies significantly and may not remain on par with video visits 2
• Understand that hospital-based ambulatory clinics may prefer more in-person visits due to loss of facility fees associated with telemedicine 2
• Consider that telehealth visits have been shown to have shorter indirect waiting times (27.7 days vs. 48.4 days for in-person) 7

For the most current and specific coverage information, providers should contact individual insurance companies directly, as telehealth policies continue to evolve rapidly.