Telehealth

Telehealth — the delivery of healthcare services using telecommunications technology — expanded dramatically during the COVID-19 pandemic and remains a significant part of the US healthcare landscape. Video visits, telephone consultations, remote patient monitoring, and asynchronous messaging with providers are now available through most major health systems, insurers, and standalone telehealth platforms. Understanding what telehealth can and cannot do, how it is covered by insurance, and how to access it helps you use this option effectively.

What telehealth can handle

Telehealth is most effective for care that does not require a physical examination, laboratory test, or in-person procedure. Services commonly delivered via telehealth include:

Mental health and behavioral health. Therapy, psychiatry, medication management for stable psychiatric conditions, and counseling are among the most widely available and effective telehealth services. Mental health telehealth expanded significantly during the pandemic and many providers continue to offer it as a primary modality.

Primary care follow-up. Checking in on stable chronic conditions — hypertension, diabetes, thyroid conditions, asthma — reviewing lab results, or adjusting medications that do not require physical findings are well-suited for telehealth.

Minor acute conditions. Many common infections (urinary tract infections, sinus infections, pink eye, certain skin conditions) can be diagnosed and treated remotely based on reported symptoms, particularly when a prescriber has access to your prior medical history.

Prescription management. Refill requests, medication questions, and dose adjustments for stable regimens can often be handled by telehealth, though controlled substances require specific conditions to be prescribed by video.

Specialist consultations. Dermatology (asynchronous photo review), endocrinology, neurology follow-up, and second opinions are increasingly available by telehealth.

When telehealth is not appropriate

Telehealth cannot replace care that requires physical presence. Situations requiring in-person evaluation include:

• Acute chest pain, shortness of breath, or suspected cardiac emergencies
• Physical examination findings (masses, tenderness, neurological signs)
• Wounds requiring cleaning, closure, or debridement
• Procedures — injections, biopsies, imaging
• Lab work and point-of-care testing
• Initial evaluation of complex conditions where a physical exam is essential to diagnosis

If you describe symptoms during a telehealth call that suggest a condition requiring in-person evaluation, the provider should direct you to appropriate in-person care, including the emergency room if urgency warrants it.

How telehealth coverage works under private insurance

Most ACA-compliant individual, family, and employer plans now cover telehealth services, though the scope and cost-sharing vary. Your plan’s Summary of Benefits and Coverage (SBC) should include telehealth coverage details — what services are covered, which platforms are in-network, and what your copay or coinsurance is.

Many insurers contract with third-party telehealth platforms (such as Teladoc, MDLive, or AmWell) as in-network services. Others work primarily through primary care and specialist networks where individual providers offer telehealth visits. Telehealth through your own in-network doctor is typically covered the same way as an in-person office visit — same copay, same network rules.

Prior authorization requirements for telehealth visits follow the same general rules as in-person visits. A telehealth visit with a specialist does not bypass HMO referral requirements, for example.

Telehealth under Medicare

Medicare Part B covers certain telehealth services when specific conditions are met. The list of covered telehealth services, originating site rules (where the patient must be located), and requirements for the type of technology used are defined by CMS and have been modified by legislation since the pandemic. The current scope of Medicare telehealth coverage — including which services are available by audio-only versus video — is available on medicare.gov.

For Medicare Advantage (Part C) plans, telehealth coverage may be broader than Original Medicare, as advantage plans can offer supplemental benefits. Review your specific Medicare Advantage plan’s coverage documents.

State licensure and cross-state care

Telehealth adds complexity to state medical licensing requirements. A physician must generally be licensed in the state where the patient is physically located at the time of the telehealth visit. For patients who live in one state and travel to another, or who live near a state border, confirming the provider’s licensure in the patient’s current state matters.

Several interstate licensure compacts — such as the Interstate Medical Licensure Compact (IMLC) — allow physicians to more easily obtain licenses in multiple states. The practical effect is that more providers now hold multistate licenses, making cross-state telehealth more accessible. Check with your provider or telehealth platform about where they are licensed to practice.

Comparing telehealth visit types

The right telehealth format depends on what you need clinically. The table below compares audio-only, video, and in-person care across common factors.

Factor	Audio-only (phone)	Video telehealth	In-person visit
Technology needed	Any phone	Smartphone, tablet, or computer with camera	None (travel required)
Insurance coverage	Covered by many plans; narrower than video	Broadly covered; check plan SBC	Standard coverage
Suitable conditions	Medication refills, follow-up, mental health	Most primary care follow-up, mental health, minor acute conditions, dermatology	Physical exam, labs, procedures, new complex conditions
Not suitable for	Physical findings, first-time complex diagnosis	Physical examination, wounds, imaging	N/A
Wait for appointment	Often same-day	Often same-day to next day	Days to weeks (PCP); longer for specialists
Privacy / confidentiality	Ensure private location	Ensure private location with camera	Clinical setting
Licensure concern	Provider must be licensed in patient’s state	Provider must be licensed in patient’s state	Same state, confirmed by practice location
Mental health	Very effective	Widely used, strong evidence base	Available; may be preferred for complex cases

What this looks like in practice

Imagine you are a 38-year-old professional who arrived in the US from Japan three months ago. You have established primary care with a physician in your city, but you develop symptoms consistent with a urinary tract infection on a Wednesday evening — urgency, burning, and pelvic pressure. Your PCP does not have next-day availability. Going to urgent care would take two hours round-trip.

You open your insurer’s app and see that in-network telehealth visits with your plan’s partner platform are available within 30 minutes and carry the same $30 copay as urgent care. You join the video visit on your laptop. The physician reviews your symptoms and medical history, determines that the presentation is consistent with an uncomplicated UTI, and sends a prescription electronically to your preferred pharmacy. You pick up the antibiotic the same evening.

Two weeks later you need a follow-up for a stable chronic condition — your thyroid medication dosage. Your own PCP is available for a video visit through the practice’s patient portal. The appointment is billed as an office visit telehealth encounter at your standard specialist copay. You do not need to travel or take time off work. Your provider can review your recent lab results during the call and adjusts your medication dose.

Step by step: setting up your first telehealth visit

1. Check your plan’s telehealth coverage. Review your Summary of Benefits or call member services to confirm which telehealth services are covered, which platforms are in-network, and what your copay will be.

2. Choose a platform or provider. Your insurer may have a contracted telehealth platform. Alternatively, your own PCP or specialist may offer telehealth — check their patient portal or call the office. Confirm the provider is licensed in your state.

3. Create an account and enter your information. Register on the telehealth app or portal with your name, date of birth, insurance information, and pharmacy preference. Having this ready before your appointment saves time.

4. Test your technology. Use the platform’s device test tool or make a test call beforehand. Confirm your camera, microphone, and internet connection are working. Find a quiet, private location.

5. Prepare your visit information. Write down your current medications with dosages, relevant symptoms (onset, severity, any prior treatment), your pharmacy name and location, and any questions you want to ask.

6. Join the visit on time. Log in a few minutes early. Most platforms send a link by text or email. Some require you to be in a virtual waiting room before the provider joins.

7. Follow up on prescriptions and referrals. If the provider prescribes a medication, confirm it was sent to your pharmacy. If a referral for in-person follow-up is needed, ask how it will be communicated to the receiving provider.

Privacy and confidentiality during telehealth visits

Telehealth visits are subject to the same HIPAA privacy protections as in-person visits — your provider’s platform must use secure, encrypted communications. However, maintaining privacy on your end is also your responsibility.

Before your visit, choose a private location where others in your household cannot overhear your conversation. If you live with others, let them know you will be on a medical call. Use headphones if you are concerned about others hearing the provider’s audio. Be aware of your camera angle — avoid having personal documents, financial statements, or identifying details visible in the background.

Platforms that are not HIPAA-compliant (standard consumer video applications that have not been configured for healthcare use) should not be used for telehealth. Legitimate telehealth platforms are built to HIPAA standards. If a provider asks you to connect via a general consumer video application without explicit HIPAA authorization, ask about their privacy compliance before proceeding.

For asynchronous telehealth — such as sending photos to a dermatologist through a secure portal — verify that the portal is part of your provider’s covered system before submitting any images or personal health information.

Mental health telehealth: access and legal protections

Mental health telehealth is one of the most well-established and evidence-supported applications of remote care. Therapy, psychiatric medication management, and counseling are particularly well-suited to telehealth because they rely on conversation and clinical observation of verbal behavior rather than physical examination.

Several federal laws protect mental health telehealth access:

Mental Health Parity and Addiction Equity Act (MHPAEA): Requires that mental health and substance use disorder benefits — including telehealth benefits — be no more restrictive than comparable medical/surgical benefits. If your plan covers telehealth for a medical condition, it must cover telehealth for equivalent mental health conditions under parity requirements.

The No Surprises Act: Applies to mental health telehealth services from out-of-network providers in the same contexts as other surprise billing protections.

Accessing mental health telehealth typically works as follows: your insurer has contracted in-network behavioral health telehealth providers — either through a platform such as Talkspace or Teladoc Behavioral Health, or through individual therapists and psychiatrists in their network who offer video sessions. If you prefer a specific therapist who is out of network, you can often file for out-of-network reimbursement if your plan has out-of-network mental health benefits.

Crisis mental health resources — such as the 988 Suicide and Crisis Lifeline — are available by call or text at any time and do not require insurance. For ongoing mental health care by telehealth, confirm your provider’s licensure in your state and whether they can prescribe psychiatric medications if that is relevant to your care.

Documents and terms you will see

When using telehealth in the US, you will encounter these terms in coverage documents, prescriptions, and licensing contexts.

• Telehealth — the delivery of clinical healthcare services using telecommunications technology, including video and telephone visits
• Ryan Haight Act — federal law requiring an in-person evaluation before a controlled substance can be prescribed via the internet, with certain exceptions
• Interstate Medical Licensure Compact — an agreement among participating states that allows physicians to obtain licenses in multiple states more easily, facilitating cross-state telehealth
• Prior authorization — insurer approval required before certain services are covered; telehealth visits follow the same rules as equivalent in-person services
• Network — contracted providers and platforms your plan covers at negotiated rates; in-network telehealth typically costs less than out-of-network
• PCP — primary care provider; many PCPs now offer telehealth visits through their patient portal or practice platform