I love telemedicine. I have long been an advocate of being able to talk to your doctor on the phone when you have a health complaint. The alternative is often driving across town and waiting in a crowded waiting room with other sick people. I have long believed the natural progression of telemedicine would be (or at least should be) people buying Bluetooth devices that check vital signs and connect seamlessly to your doctor’s computer to make telemedicine even more robust. This would help your doctor know even more about your medical complaint than listening to you on a cellphone or seeing you through a grainy video feed. I can also imagine a kiosk at your local pharmacy where you reserve a booth that is designed to facilitate communication between doctor and patient. Telemedicine has so much potential.
I hesitate to admit it, but I just read about a dark side to telemedicine. The dark side I’m referring to are consultations of minimal value billed at high prices by a doctor you’ve never met. These appear to be the exception, however Kaiser Health News reported on one such visit:
Last year, Elyse Greenblatt of New York City scheduled a telehealth appointment through her usual health system to see if her nagging congestion was covid-19. After meeting virtually with a doctor for a short time, she was told it was probably not covid and given a prescription. The appointment turned out to be quite costly: nearly $700
That proved an expensive decision. She remembers the visit as taking barely any time. The doctor decided it was likely a sinus infection, not covid, and prescribed her fluticasone, a nasal spray that relieves congestion, and an antibiotic, Keflex.
To make matters worse the doctor who consulted with Greenblatt was not in her network despite being affiliated with the in-network hospital. The out-of-network physician resulted in a surprise medical bill. Because the consultation was out-of-network, her health insurance rejected the claim, and it became her expense.
KHN could not verify the doctor was in any provider network. Why would a hospital employ a physician who was not affiliated with any of the hospital’s networks unless it was to ambush unsuspecting patients with higher prices? Then the hospital said the patient signed forms agreeing to an out-of-network physician should one be provided. Patients have become conditioned to sign forms as part of a check-in process. Was this hospital profiting off surprise billing arrangements by making patients sign forms with language buried in the fine print? That shouldn’t be allowed. Keep in mind, forms are never for your benefit; they’re always for the benefit of the people requesting you sign them.
Even with an out-of-network physician the bill was excessively high. Why $660? And why was it billed as a 45-59 minute visit if, as she recalled, it took little time? The doctor also billed it as a complex case requiring a lengthy discussion, while the patient recalled it as simple, taking no time at all.
“I think it was five minutes,” she recalled. “I said it was a sinus infection; she told me I was right. ‘Take some meds, you’ll be fine.’”
Greenblatt retraced her steps on the hospital website, which came up with an estimated fee of $60. That sounds about right to me for a 5- or 6-minute telephone call. According to KHN:
A $60 fee would be in line with, if not a bit cheaper than, many other telehealth services. Doctor on Demand, for example, offers visits from a clinician for $79 for a 15-minute visit, assuming the customer’s insurance doesn’t cover it. Amazon’s new clinic service, offering telehealth care for a wide range of conditions, advertises that charges start at $30 for a sinus infection.
KHN concluded by suggesting you time your physician telemedicine visits (better yet, record them). Since KHN raised the issue of Amazon Clinic services starting at $30 for a sinus infection (which is what Greenblatt had) I will add this. Earlier this year I wrote about Amazon entering the primary care arena with the purchase of One Medical here and here. (It’s not clear whether Amazon Clinic and One Medical are related except by a parent company)
Although One Medical has physical brick & mortar clinics in some cities, much of the care is telemedicine, over text, telephone or video chat. I love Amazon so I had high hopes for the service. However, I began to have reservations about Amazon’s One Medical. The firm has numerous complaints at the Better Business Bureau and on Trust Pilot. The primary concerns are short calls for minor problems generating unexpectedly high bills. One patient complained about an 8-minute call costing $225, while another complained a call of the same length was billed at $195.20. Another patient told Trust Pilot:
I had precisely a 7-minute consultation (Dr was late)
The cost was $600, and nothing was accomplished.
The prescription was rejected by insurance & they do not provide follow-up like a normal doctor. I literally burned up $600+ the $199 membership in 7 useless minutes.
This is the biggest scam ever, hugely disappointed.
While another said:
I was charged nearly $500 (after insurance) for a 10-minute video chat with a doctor. It was listed as “Low Complexity” but still came out to this ridiculous bill. I’ll be skipping the lab follow up, since I don’t want another unexpected charge like this.
Telemedicine has great potential and is especially beneficial when you’re working with a doctor who knows your medical history. I’m also a fan of TelaDoc, which allows you to talk to a doctor from virtually anywhere for low, transparent prices. I’m not a fan of hospitals using telemedicine as a new way to ambush patients with unsuspecting out-of-network surprise medical bills. I’m also not a fan of opaque bills for opaque services that range from $60 to $660 with no warning in advance. I hope these are the exception.