This Tuesday, Jan. 26, the Rhode Island Senate will potentially pass a bill, S0004A making it harder for Rhode Islanders to access telemedicine (computer or phone medical visits). We urge voters to contact their State Senators to encourage them to vote in favor of the amendments described below that will protect patients’ rights over insurers’ profits.
Before Covid, health insurance companies offered very limited coverage of telemedicine, despite the clear benefits to patients. These benefits include allowing patients to: take less time off from work, avoid transportation costs, avoid the stress of the office visit, and avoid risks of infection – all benefits especially important to low income patients, the elderly, and those with mental and physical challenges.
Since Covid, insurers have covered telemedicine and waived co-pays, deductibles, co-insurance and prior authorizations that typically discourage and delay care, because of the Governor’s Executive Orders and voluntary compliance. As a result, telemedicine visits have increased by about 30% while in-person visits have fallen proportionately.
In June 2020, the Rhode Island Senate passed S2525A, a bill that protected patients’ access to telemedicine. Unfortunately, the House failed to pass this bill. Now, the Senate leadership has offered up, with short notice, S0004A – a bill that offers weaker protections for patients and stronger protections for health insurance companies. It is important to stress that insurance companies have enjoyed high profits and surpluses last year because people have used less elective health care and have delayed needed care during the Covid pandemic.
PROBLEMS with S0004A
1: Allows insurers to pay specialists less for telemedicine services than for in-person visits.
S0004A requires insurers to pay primary care/behavioral health providers for telemedicine services an equal amount to what they would get for in-person visits, but does not require the same for medical specialists and other health care providers. Health insurers claim that requiring parity for all health care providers would somehow harm patients by “driving them to telemedicine.”
In fact, as Rhode Islanders now realize, making it easier for people to attend specialist visits via telemedicine offers significant benefits to patients. Telemedicine visits can lower the risk of exposure to Covid, reduce time off from work, lower transportation costs, and reduce obstacles to essential specialty care for individuals with disabilities.
2. The term “clinically appropriate” is inserted 27 times to allow insurers to limit medically necessary coverage
“Clinically appropriate” was not included in S.2525A, a bill to enhance patients’ access to telemedicine, but is used 27 times in the S0004A. Why? The term “clinically appropriate” has no accepted definition. Patients and doctors are already protected from inappropriate insurance company denial of coverage by the requirement that services be “medically necessary,” which means that if the service is effective and needed, the insurance company has to pay for it. The only possible explanation for including “clinically appropriate” is to give insurers a way to refuse coverage of medically necessary telemedicine services that avoids the medical science behind “medically necessary” justification for coverage.
The term “medically necessary” has been in use since the introduction of Medicare in 1966 and is the gold standard, used for decades by the health insurance industry to determine what, when and where care should be delivered. Its meaning is and always has been determined by an independent group of medical experts as, “…needed for the diagnosis or treatment of your medical condition” and “meets the standard of good medical practice in the local area.” This independent group also reviews innovations in care so the list of “medically necessary” services is constantly updated based on evidence. The term, “clinically appropriate” must be removed from S0004A to prevent insurers from using the term to deny medically necessary care.
3: This bill excludes health plans that insure about 50% of Rhode Islanders
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Although S0004A deems telemedicine essential, access to telemedicine as described in this bill will not be available to those insured by ““short-term travel, accident-only, limited or specified disease; or individual conversion policies or health plans; nor to policies or health plans designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare; or any other similar coverage under state or federal governmental plans.”
This language means this bill only applies to those insured by their employer and those on Medicaid. The elderly and the disabled (Medicare), the unemployed (COBRA), and people with no alternative who buy low-value high deductible plans recently allowed by the Trump administration are all excluded. In other words, the most vulnerable are excluded. Thus, approximately half of Rhode Islanders will not benefit from a bill whose original intent was to improve access to telemedicine but now does not unless this exclusion is removed.
4. Waivers of co-pays, deductibles, co-insurance and prior authorizations for telemedicine are not continued during Covid despite the on-going need to reduce infection risk
Covid is an ongoing public health and economic crisis facing Rhode Islanders. Freedom from co-pays, deductibles, co-insurance and prior authorizations increases patients’ access to telemedicine care. The legislature should not just hope that waivers made voluntarily or because of the Governor’s Executive Orders will continue. The Senate recognized this when it passed S2525A and should continue to recognize it today by amending S0004A to continue the waivers. The profits of insurance companies must not be allowed to outweigh the benefits of making telemedicine affordable for patients and providers.
We urge readers to call their Senators and ask them to support amendments that correct these four problems with the S0004A. A vote against such amendments, is a vote for protecting health insurance company profits over patients’ access to telemedicine.
- J Mark Ryan, MD, FACP, Chair, Physicians for a National Health Program, RI Chapter (PNHP-RI)
- James A Cowan, MD, MPH, Board member, PNHP-RI
- Anita S Kestin, MD, MPH, Board member, PNHP-RI
- Linda Ujifusa, Esq, Co-Chair, RI Healthcare Access & Affordability Partnership (RIHAAP)