Need to See Your Doctor? Try Telemedicine. 

By Mary Anne Dunkin

Are you having a flare? Are you– or someone who lives with you – due for a routine doctor’s appointment or experiencing troubling respiratory symptoms? “Pick up the phone, not the keys,” advises Rena Brewer, CEO of the Global Partnership for Telehealth, a nonprofit agency focused on increasing access to healthcare through technology. Many of the issues that once required a visit to the doctor – even as recently as a few months ago – can now be handled more safely through telemedicine.

Because of the new coronavirus, health care providers are seeing many patients remotely, by telephone or video, and federal confidentiality laws have been relaxed, making these consultations easier.     

What Is Telemedicine?

Telemedicine involves seeing a doctor remotely via a two-way video and/or audio connection. Historically, the doctor would be in his office in front of his computer and the patient would be in an exam room with a computer, webcam and a presenter – usually a medical assistant trained to do a physical exam and gather basic patient information. Using this model, patients in rural clinics and hospitals could access specialists at major medical centers; nursing home residents could be examined by a doctor without leaving their beds; and children in some disadvantaged areas could have checkups from their school nurse’s office with a pediatrician. But for many people wanting to see their rheumatologist, it meant very little – until now.

In the past, rheumatologists have been slow to adopt telemedicine because of barriers, including insurance coverage, HIPAA compliance (for confidentiality) and licensing issues (providers had to be licensed in the state the where the patient was receiving treatment), say Daniel Albert, MD, a rheumatologist at Dartmouth-Hitchcock Medical Center, who incorporates telemedicine into his practice.

In addition, doctors and patients preferred in-person visits (in part so that the doctor could physically examine joints) so telemedicine was never widely adopted in rheumatology.

“Then here comes COVID-19, a special set of circumstances where in-person encounters are discouraged,” says Dr. Albert. “Both patients and physicians are reluctant to have in-person encounters.”

To reduce the need for such encounters and improve efficiency, the U.S. Centers for Medicare & Medicaid Services have eased some of these barriers, making it possible for new and esstablished patients to see their doctors for COVID-19 concerns, routine rheumatology visits and even appointments with mental health professionals.

Under the Telehealth Services During Certain Emergency Periods Act of 2020 (which passed and is retroactive to March 1), part of the Coronavirus Appropriations Act, the secretary of Health and Human Services (HHS) is authorized to temporarily remove restrictions on the patient’s location in certain emergency situations for telehealth services to Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. This means the patient does not need to be in a clinic or in a rural area for Medicare, Medicaid or CHIP to cover telemedicine visits. The bill also allows Medicare, Medicaid or CHIP beneficiaries to receive telehealth services via their smartphones and removes geographic licensing restrictions, allowing doctors to treat patients even in states where they are not licensed.  

Make a Telemedicine Appointment

To receive telemedicine, you’ll simply need a phone, a computer with a microphone and webcam, a tablet or a smart phone.

Unless you have symptoms that the health care provider needs to see, you’ll probably be able to get the consultation by telephone.

In some cases, the doctor’s office will email you a web link where you can register or an app for you download. The app will connect you to a patient portal where you can see and speak with your doctor at your appointment time. Under the relaxed regulations, your doctor may consult with you only by phone; if he requests video so he can see you, you can use a common application like Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom or Skype, (but not public platforms like Facebook Live or TikTok).

If your doctor doesn’t offer telemedicine visits, ask if they will in the near future, and consider rescheduling your appointment if it isn’t urgent.

(Pet fur can spread the new coronavirus, too, so take similar precautions for veterinary appointments. The Food and Drug Administration is now permitting telemedicine for veterinary care, so if your pet needs medical attention, call ahead to see if he or she can be treated without exposing yourself or your pet to potential carriers at a veterinary office.)

What Telemedicine Can and Can’t Do

One limitation of telemedicine, of course, is that a hands-on exam by your rheumatologist is not possible. However, it can be useful for addressing urgent care needs, including screening for possible COVID-19, says Brewer, which many public and private insurers are covering during the pandemic.

You aren’t likely to have the stethoscopes, otoscopes and devices that can transmit images to your doctor that would be in a clinical setting, so your visit will be limited to what you tell your doctor and what she observes.  

“They can see how you are breathing, they can hear if there’s a cough. They can talk to you and assess symptoms in general and tell if you are sick,” she says. “If you have a digital thermometer you can hold it up and show the provider.”

Before your consultation, be sure to have a list of your medications and medical history, including your conditions. If you have a home thermometer or other testing devices for glucose, blood pressure etc., have those on hand as well; the doctor may want your results or, if you are using video, watch how you use the equipment to make sure you’re getting a correct measurement.

Apps for Urgent Care

If you have an acute illness unrelated to your arthritis, your first choice should be to contact your primary doctor who knows you and your medical history, says Brewer. But if your primary care doctor is unable to see you or does not offer telemedicine, you might consider an urgent care app, such as Doctor on Demand or MDLive, which give you virtual access to a primary care doctor 24/7.

Once you download and open the app on your phone, it will provide a list of available doctors along with their pictures and profiles. You select the doctor you want to see, and if the doctor is available, you can click to see him or her immediately or schedule a convenient time for a call back. The app does the rest.

If the doctor determines you need a prescription, she can send it to a pharmacy of your choice. (Be sure the pharmacy has delivery or a drive-through window so you don’t need to walk inside for your prescription.) The doctor can also advise if you need to be seen in person or to go to an ER.

Paying for Telemedicine

The cost of a telemedicine visit will vary based on your insurance type, but traditionally in most cases, it will be the same as an in-person visit. However, many are making exceptions during the pandemic.

• Private Insurance. At this time, many private insurers, including Aetna,  Blue Cross Blue Shield and United Health, are waiving copays or cost sharing for many telemedicine visits, beyond COVID-19-related visits. Aetna, for example is offering zero copay telemedicine visits for any reason. Contact your insurer to see if and what telemedicine visits are covered.
• Medicare. For Medicare beneficiaries, coinsurance and deductibles for telemedicine visits may apply, though some health care providers are reducing or waiving the amount you pay for visits. If you have coverage through a Medicare Advantage Plan, providers may also offer more telehealth services than your original plan. To find out how much your test, item or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several factors, including other insurance you may have; how much your doctor charges; whether your doctor accepts assignment; the type of facility; where you get your test, item or service; etc.
• Meicaid and CHIP. Coverage for telemedicine visits for Medicaid and CHIP beneficiaries varies from state to state.

If you are not sure what your insurance covers, check your policy and call your health care provider to confirm before scheduling your visit.

The increasing ability to conduct health care visits virtually or by phone or postponing nonessential visits will help prevent the spread of the virus. “Reducing your contact with other people either in waiting rooms or in clinics or hospital visits is the right thing to do,” says Dr. Albert.