Guide to Pricing Video Visits

Confusion over reimbursement policies for telemedicine appointments contributes to slow adoption among healthcare providers around the county. The emergence of telehealth technology has created a cloud of uncertainty on the economy of care.  Innovative providers are deciding not to wait for the industry to catch up by offering video visits out-of-pocket…either as the only payment option, or in conjunction with reimbursable services.

If you are trying to decide where on that spectrum your practice will fall, here is a helpful primer on navigating that decision.

Know the Rules

If you are billing out-of-pocket for some patients and to insurance for others, you need to keep in mind the Balance Billing law first and foremost. Here it is in a nutshell:

• Your charge-per-visit can be whatever you choose.
• If you are contracted with a patient’s insurance (in-network), and they cover live video telemedicine, you must accept what they state the fee is (copay + insurance payment) and you must waive the remainder (the “balance”) – you cannot bill the patient for it.
• If you are not contracted with the patient’s insurance (out-of-network), you may charge them the full fee at the time of service and they can be reimbursed for whatever out-of-network benefits they have. Conversely, you can also bill their insurance, accept whatever payment they submit, and then bill your patient for the balance (provided the patient is aware that they will receive that bill.)
• If your patient’s insurance does not cover video visits, you may bill them for the entire charge.
• In all cases, be sure to have a notice of payment practices reviewed and signed by your patient before conducting any telemedicine appointments.

Billing your video visits directly to your patient can be well worth the time it takes to answer these questions for yourself – removing the headache of dealing with commercial insurers and state reimbursement policies is incentive enough for most practices who choose this route.

Bypassing the Payers

While we are all aware of the intricacies of reimbursement for telemedicine, what if your payment model doesn’t include billing insurances at all for your virtual visits? When your patients are paying out-of-pocket only, it changes the game – it removes the snags that insurers can often create in your quest to get paid, but it also introduces a new set of questions:

How much should I charge?

According to recent surveys, out-of-pocket telemedicine visits are an average of $30-75 nationally, with most visits at around $40-50. Medicare pays around $50 per visit on average, and, in the way of large commercial services, Teladoc charges $45, AmWell $69, eVisit $60, and Doctor on Demand $38. However, Becker’s Hospital Review just published an article reviewing 7 vastly different price profiles for video visits:

1. Doctor on Demand and Humana’s health plan On Hand charges $0 to $5.
2. Walmart offers its employees $4 telehealth appointments.
3. SSM Health in St. Louis charges $25.
4. Summa Health in Akron, Ohio, charges $30.
5. McLaren Health Care in Grand Blanc, Mich., charges $49.
6. Akos MD charges $75 to $99.
7. Stanford Children’s Health and Stanford Health Care, both in Palo Alto, Calif., charge $700 for its Grand Rounds program, which offers digital second opinion consultations from Stanford physicians.

Pricing Considerations

Given all this, how do you decide the pay rate for your telemedicine appointments? Here are a few considerations to think about when determining what you are going to charge: 

Types of Treatment

What conditions/types of patients are you treating? If you have a large amount of chronic care patients or ones you have regular visits with (therapy, dietary counseling, etc), a subscription or monthly plan might work best. For remote speciality care consultations, you might charge a higher fee than for primary care services. For specialities that have follow-ups included in the global fee when using insurance, you might be able to use virtual care follow-ups as a way to generate profit you didn’t before (eg., orthopedic/surgery/procedure follow-ups) 

Technology Requirements

What technology do you need? How much is it going to cost to install or implement, and how much will it cost for upkeep? If you are having to invest in new technology or services, you can include a “technology” or “equipment fee” in your price-per-visit.

Market Analysis

What is your competition doing? Probably one of the best ways to decide pricing: see what your direct or close competitors are charging for the services you want to provide! Also look at what quick-care providers in your area are charging: urgent cares often do fee-for-service, and telemedicine is based off of the idea of “quick-care” and convenience, which is what urgent cares are useful for as well. One article stated this: “For instance, if you’re a family practitioner and you’ll likely be diagnosing colds, sinus infections and UTIs on a regular basis, find out what your local urgent care center or retail health clinic would charge for a similar service. Consider where your patients would go if they didn’t have the option of telemedicine, and consider what will make a video call worthwhile. What would the patient’s cost be if they were treated in-office? Factor in the cost of things like travel and taking time off work.”

In 2010, a study from Harvard Medical School determined the average doctor’s visit costs patients $43 in lost work time, which would be much more now. In other words, you can charge more as a “convenience fee” onto telemedicine visits than for the same in-office services since they won’t have to pay for gas or time off, but don’t charge more than other retail or urgent care clinics are charging for the same service. While most patients (according to a nation-wide survey) would prefer to see their own physician, or one they have an established relationship with through telemedicine), most will end up doing what has the best combination of affordability and convenience.

If adding video visits would be a benefit to your practice and patients, you still have to make a business case for its effect to the bottom line. Using a creative approach to compensation, within the rules, might be the answer for the success of your telemedicine program.

For more information and resources on pricing and policy, browse through our library at simplevisit.com/resources or call a SimpleVisit telemedicine consultant at 877.83.VISIT (84748).