ELM GROVE -- The use of telemedicine -- that is, a doctor appointment on your computer -- has spiked due to COVID-19. Experts predict the outbreak will dramatically change how many people receive care, so why was one family told it wasn't covered?
Jessica Kagel's 7-year-old son has monthly visits with a therapist at Red Oak Counseling in Elm Grove. "It's mainly just to help him cope with things that are hard for him to do," Kagel said. With school closed, he needs it more than ever. But Kagel said Molina Healthcare told her that it does not cover telemedicine. "But they won't give me a reason," she said. Molina provides coverage through Medicare and Medicaid. In response to the COVID-19 pandemic, Medicare has expanded its coverage of telemedicine. Last year, Wisconsin lawmakers passed a bill that expanded Medicaid reimbursement for telehealth.
"It's a really good public policy," said State Sen. Alberta Darling. "It enabled Medicaid and Medicare people to get reimbursed, to have their physicians get reimbursed, which is huge." Darling was among the policy's bi-partisan supporters, and even supports going one step further -- a law requiring all health insurance companies to cover telemedicine. "I think it's a really good idea, especially with COVID-19 and the contagion issue," Darling said. "I think it's really important no matter what your insurance that you have access to it." Red Oak Counseling told Contact 6 that access to mental health care is critical, especially now. Shortly after Contact 6 reached out to Molina on Kagel's behalf, she got a call from the insurance provider saying her son's therapy would be covered. In a statement to Contact 6, Molina Healthcare said:
Molina Healthcare of Wisconsin is indeed covering telehealth benefits for Medicaid members during the current emergency order. This has been communicated to both the Molina member and provider. We apologize for any misunderstanding.
Patient Advocate Debby Deutsch of Patient Care Partners, LLC, said most major health insurers do cover virtual appointments, but never assume that yours will.
"If something is covered in an in-person visit, it will very likely be covered in a telemedicine visit," Deutsch said. "Always check your benefits, always check the insurer's website." Deutsch says Cigna, United Health Care, Blue Cross Blue Shield, Aetna and Humana all offer telemedicine support. Kagel's son has his first tele-therapy session on Monday to help him cope with the frustration that comes with home-schooling. If you would like more information about telemedicine coverage through Medicare and Medicaid, CLICK HERE.