Telehealth emerges as viable option during crisis



Picture in your mind a visit to your doctor. You’re asked how you’re feeling. Your temperature is taken. You step on the scale. You open your mouth and say, “Ahh!”

Now, picture your doctor responding, “Can you move the iPhone camera a little closer to your mouth so I can better see down your throat?”

In the years since the development of sophisticated communications devices like tablets and smartphones, many in the medical profession had barely dipped their toes in the water of telehealth — the use of electronic devices to facilitate remote visits.

But the current COVID-19 pandemic — and a consequent relaxation in insurance restrictions — has forced doctors to dive headfirst into virtual medicine.

“With the pandemic, we literally transitioned our practice in 48 hours to completely, 100% virtual,” said Iolanda Marucci, founder of Tides of Mind Counseling, a Waterbury-based mental health practice. “It was quite an adjustment. This is new to many of the staff.”

About 10% of her staff practiced telehealth prior to the pandemic, she said.

“We have 55 clinical staff members who did not do telehealth at all,” she said. “It was a big learning curve for them.”

Before the pandemic, practitioners said, there was little incentive, or even practicality, to expanding their practices virtually because insurance companies didn’t cover most telehealth visits and were restrictive on the ones they did cover.

Much of that changed after hospitals began struggling with an overrun of coronavirus patients, and smaller and specialty practices were advised to close their doors.

In March, President Donald Trump made a series of administrative decisions that expanded Medicare telehealth benefits.

According to the Centers for Medicare & Medicaid Services, or CMS, Medicare began on March 6 paying clinicians to provide telehealth services for beneficiaries living across the country.

About a week later, Medicare telehealth benefits were further expanded after Trump invoked the Stafford Act and the National Emergencies Act, according to the CMS.

Medicare was previously only allowed to support telehealth services under certain circumstances, such as the patient needing to live in a rural area and to travel to a local medical facility to get telehealth services from a remote doctor.

Also previously, telehealth services were not allowed to be received in the patient’s home, CMS documents indicate.

Coverage of telehealth by private insurance varies greatly and under constantly changing rules, practitioners said.

“Claims would bounce back if one little code was incorrect. These codes we’re looking at were all new to us,” Marucci said. “The communication with each insurance we take was crucial.”

The insurance industry group America’s Health Insurance Plans lists new telehealth rules for dozens of plans on its website,

For example, the group reports that Aetna now offers zero co-pay for telemedicine visits for any reason, while Anthem is doing the same, but limiting the period to 90 days from March 17. Blue Cross Blue Shield has a similar 90-day rule. Cigna, however, appears to only allow telehealth in the diagnosis of COVID-19.

“One of the guidances the Medicare services said was, in the past, I believe you could only do telemedicine with established patients,” said Dr. Jeremy Moss, a Bridgeport-based dermatologist who is a partner in Integrated Dermatology, which has an office in Waterbury.

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