Telemedicine is a general term that covers all of the ways you and your doctor can use technology to communicate without being in the same room. It includes phone calls, video chats, and more.
Certain telemedicine and remote care services are covered when provided by an in-network provider. These remote services should maintain the quality, safety, and effectiveness of an in-person visit. You should work with your provider to determine the best technology solution(s) to meet your care needs.
This page outlines different telemedicine services covered by the State of Wisconsin Group Health Insurance Program. Costs vary by telemedicine service.
If you are seeking advice for an urgent or emergent medical event, contact your health plan or medical provider. If you are looking for in-network providers or an emergency room, contact your health plan.
Telemedicine Cost Sharing
Click on the service category name to learn more about each telemedicine offering.
| Service Category | Non-HDHP Plans | HDHP Plans |
|---|---|---|
|
|
$0 |
Deductible, then $0 |
| Telehealth Visit |
$15 / $25 copayment per visit, depending upon provider specialty |
Deductible, then $15 or $25 copayment per visit, depending upon provider specialty |
| Telephone Visit |
$15 or $25 copayment per visit, depending upon provider specialty |
Deductible, then $15 or $25 copayment per visit, depending upon provider specialty |
| Remote Patient Monitoring | $15 for each 30-day period of monitoring | Deductible, then $15 for each 30-day period of monitoring |
| Virtual Check-In | $0 / $15 / $25 copayment per visit, depending upon vendor and provider specialty | Deductible, then $0 / $15 / $25 copayment per visit, depending upon vendor and provider specialty |
E-Visits
An evaluation and treatment by a provider using a patient portal, preferred or vended portal, email, or secure messaging which can include text, images, or videos. Services must address an issue that would typically require an office visit and be patient-initiated. An E-Visit is also called a digital visit or a virtual visit.
E-Visits must be initiated by the member seeking services, not the provider, in order to be covered.
E-Visits are covered when the same service would be covered if provided in person when performed by one of the following provider types:
- Doctor
- Nurse practitioner
- Physician assistant
- Licensed clinical social worker
- Clinical psychologist or psychiatrist
- Occupational therapist
- Speech language pathologist
Telehealth
Telehealth is a service delivered via real-time audio and video. Telehealth may also be called telemedicine, online or virtual evaluation and management, or a video visit. Telehealth services include office visits, psychotherapy, consultations, and certain other medical or health services that are provided by a doctor or other health care provider who is located elsewhere using interactive two-way, real-time audio and video technology. Telehealth can be provided in your home, as well as at a health care facility.
Telehealth will be covered by your health plan if those services are delivered:
- Outside of your physical presence (e.g., remotely),
- When both audio and video elements are present, and
- When there is no reduction in the quality, safety, or effectiveness of the service.
If you and your provider determine that you cannot successfully complete a Telehealth visit with full audio and video, you may opt to change to a Telephone Visit.
Telephone Visit
A Telephone Visit is an evaluation and treatment by a provider using audio-only. Services must address an issue that would typically require an office visit and be patient-initiated.
Telephone visits will be covered if the provider can successfully provide the service without a reduction in quality, safety, or effectiveness.
Remote Patient Monitoring
Remote Patient Monitoring is the collection and interpretation of a person’s physiologic data that is sent digitally to a health care provider to support treatment and management of medical conditions.
- Monitoring must take place for a minimum of 16 days for the service to be covered; monitoring for shorter periods will not be covered.
- Device must meet home-use medical device as defined by the Food and Drug Administration and be provided as part of the monitoring service.
- Devices are provided as a lease; they cannot be lease-to-own, purchased to own, or already owned.
Virtual Check-In
A brief discussion either by telephone or real-time audio and video between a provider and an established patient to manage a medical condition. These are services separate from and less intensive than Telehealth, Telephone Visits, or E-Visits.
Covered as a Virtual Check-In as long as the check-in is not related to another medical visit within the past 7 days, and as long as the check-in does not lead to a medical visit within the next 24 hours or the next available appointment.