Insurers generally cover outpatient telehealth visits in places where we offer this service. However, we can’t guarantee that your insurer will cover the visit. The best way to avoid any surprises is to speak to your insurer before your telehealth visit.
To check if telehealth is covered by your child’s health insurance plan:
Call the member services number (listed on the back of your child’s insurance card) and ask about telehealth. Here are some questions you may want to ask:
- Is the telehealth service that I want covered by my child’s health insurance plan? Describe the type of visit and who the visit is with. For example: a pulmonology telehealth visit to manage my child’s asthma, or a telehealth visit with a dietitian to manage my child’s celiac disease.
- Are there any restrictions to my telehealth coverage?
- Is there a limit on the number of telehealth visits I can have?
- What is the cost of a telehealth visit? Does it cost the same as an in-person visit? Your cost can be made up of a copay, coinsurance and/or deductible, depending on your plan.
- Is there any difference in my coverage if the telehealth visit happens while my child is at home, rather than at a clinic such as our primary care provider’s office?
If the telehealth service you want is not covered:
We recommend asking the representative to tell you where to find the link on their website that defines the specific telehealth services policy. Then you can see if they are applying the policy correctly to your child’s medical needs. During the COVID-19 pandemic, also ask the representative about any exceptions to the policy that may not be easily found on the website.
How to file an appeal:
If the telehealth service you want is not covered, you may also be able to appeal. Ask the agent to connect you with a supervisor or someone from their appeals department. When requesting an appeal, explain why telehealth would be better than in-person care for your child. If you are approved for the visit after an appeal, please request documentation and an authorization number for your records. A more long-term, time intensive option is to ask how you can advocate for change to the policy that includes telehealth coverage for your child.
You can also choose to pay the cost of the visit on your own in case your child’s health plan does not cover telehealth services. This option may make sense if:
- You have a high-deductible plan
- It would cost you more money to travel to one of our in-person clinics
- You would have to miss work for an in-person visit.
Please let your appointment scheduler or health care provider know if you would like to have an in-person visit at one of our campuses. Whether it’s in-person or telehealth, we strive to give you the best experience possible.