The number of Pennsylvanians who have come to rely on phone and video appointments surged after the pandemic made in-person visits potentially dangerous. And many health-care providers and insurance companies quickly embraced telehealth as a necessary way of getting patients needed care. But the state is one of only seven that does not have any law governing or regulating telehealth, resulting in a patchwork system of care.
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Story by Danielle Ohl of Spotlight PA
HARRISBURG — Cheryl Gibson was in pain as she drove.
Eight months earlier, Gibson had begun an at-home breathing treatment for her emphysema when the mild headache she’d felt at the base of her skull exploded into debilitating pain. Her arm went numb, causing her to drop the nebulizer tube she’d been holding. Gibson was sure she had suffered a stroke, but months of subsequent tests and scans have failed to identify the cause of the unpredictable pain she now experiences multiple times a week.
Without a way to know when an attack is coming, and with preexisting conditions that limit her mobility and increase her risk of getting seriously sick from COVID-19, Gibson relies on telehealth appointments to see her neurologist and other doctors.
The number of Pennsylvanians who have come to rely on phone and video appointments surged after the pandemic made in-person visits potentially dangerous. And many health-care providers and insurance companies quickly embraced telehealth as a necessary way of getting patients needed care.
“Pennsylvania is definitely a little bit of an anomaly in that,” said Kathy Hsu Wibberly, director of the Mid-Atlantic Telehealth Resource Center. “And strangely enough, there are so many states that have moved to creating laws and Pennsylvania has struggled.”
For the last five years, Sen. Elder Vogel (R., Beaver) has been trying to pass legislation that would allow the state to oversee health providers practicing remote medicine and explicitly require insurers to reimburse for it. But each year, the measure has failed.
In 2016, it never came out of committee. In 2018, it passed the Senate but died in the House. Last year, the bill passed both chambers, but Gov. Tom Wolf vetoed it after Rep. Kathy Rapp (R., Warren), who chairs the House Health Committee, amended it to prohibit providers from prescribing abortion-inducing medicine via telehealth.
Because there is no law mandating telemedicine in Pennsylvania, there’s nothing barring providers from practicing it, but insurers are not required to cover it. In other states, laws provide parity between in-person and remote health-care services.
Instead, insurance companies decide what kinds of telehealth appointments are covered based on their own policies and the agreements they may work out with health-care networks or individual doctors.
This can result in providers declining telehealth services even when a patient’s insurance covers them. Gibson, who receives coverage through a private insurer under the Medicare program, recently called the company to set up a telehealth appointment after she felt a cold coming on.
The first doctor she connected with over the phone refused to treat her.
“They told me they can’t talk to me about anything like that, that’s not what telehealth is for,” she said.
The next day, a call with a third doctor finally resulted in a prescription.
No guarantees
While a vital tool, telehealth has its limitations, according to patient advocates, especially for people with disabilities or those who lack access to technology.
“Telehealth in many ways has been helpful in getting additional attention on medical needs, but it’s not a catchall, it’s not a panacea,” said Patrick Keenan, the director of consumer protections and policy for the Pennsylvania Health Access Network.
Still, patients and providers across Pennsylvania have come to rely on telehealth to access care they otherwise wouldn’t be able to — despite the lack of clear regulation.
Maria and Peter Welsh, a couple from Allentown, tried driving their son Robert two hours to his specialist appointments after he suffered a traumatic brain injury while driving home for Thanksgiving last year. But Robert’s injury made the changing light and the movement of the car intolerable, and the pandemic made leaving the house risky for Peter and Maria, who are in their 80s. Robert now sees his doctor every few weeks via video call.
