Quick, Routine Telehealth Visit Results in Out-Of-Network Charge for One Consumer  

By Consumers for Quality Care, on January 17, 2024

Quick, Routine Telehealth Visit Results in Out-Of-Network Charge for One Consumer  

A consumer seeking some quick medical advice via a telehealth visit through her usual health system was charged more than $600 for out-of-network care, according to KFF Health News

After returning home from a trip to Rwanda, Elyse Greenblatt, 38, of Queens, New York, scheduled a telehealth urgent care appointment for what she suspected was a sinus infection. She used her normal health system, Mount Sinai, and was connected to an urgent care doctor for an appointment that she thought was quick and routine. The doctor prescribed her an antibiotic and then sent her on her way.  

When Greenblatt scheduled the telehealth appointment, she was randomly assigned to a doctor who unbeknownst to her, was outside her insurer’s network. The bill came to $660, leaving Greenblatt on the hook for the entire charge.

Insurers and consumers alike have embraced telehealth as a time-saving and cost-saving measure. KFF Health News found the prices for telehealth care typically range from $30 to $120, leaving consumers with a modest bill after their insurance kicks in. In Greenblatt’s case, part of the reason for the abnormally high charge may be because the visit was described as “moderately lengthy” by the doctor, yet Greenblatt remembers the visit being quick and straightforward. “I think it was five minutes. ‘I said it was a sinus infection; she told me I was right,’” said Greenblatt.

Additionally, under the No Surprises Act, consumers like Greenblatt must be notified ahead of time if a medical visit or procedure in a hospital setting will be deemed out-of-network. However, because it’s unclear what entity – Mount Sinai or the urgent care physician – provided the telehealth services, protections provided by the law might not apply in this case.

Greenblatt’s bill is still unpaid, and the situation remains unresolved.   

CQC urges all consumers to be smart shoppers when seeking medical care. CQC also calls on relevant government agencies to implement stronger telehealth price transparency policies so that consumers may have accurate information about the cost of virtual telehealth appointments. Finally, loopholes in the No Surprises Act must be addressed by lawmakers and regulators. Consumers shouldn’t be saddled with crippling medical expenses through no fault of their own.