Insurance Barriers to Telehealth Access

Insurers can create barriers by requiring in-person visits for care or prescriptions you already receive. However, insurers and healthcare providers are still subject to disability access laws, including the ADA, ACA Section 1557, Section 504, & many Medicare/Medicaid requirements.

If a disability makes in-office visits difficult or potentially harmful, patients may have a right to reasonable modifications, including telehealth access. Blanket in-person requirements without individualized consideration of disability-related needs may violate disability discrimination laws.

To shift the discussion from a discretionary request to a legal accommodation process, these strategies can help:

• Use specific legal language. State that you are requesting a reasonable modification under the ADA & would like to begin the interactive process regarding healthcare access. Ask whether the refusal is based on clinical necessity, legal requirements, or only office/insurance policy.

• Cite past telehealth success as proof of a reasonable modification.

• Get a contrast letter. Ask your physician to briefly document the risks of travel compared to the relative safety and appropriateness of telehealth.

• Request the denial in writing. Ask for the specific clinical criteria, policy, or guideline used to deny telehealth access. Insurers are generally required to provide the basis for denials, & sometimes no written rule actually prohibits telehealth in the situation.

• File complaints or appeals if necessary. Depending on the situation, patients may file internal insurance appeals, complaints with state insurance regulators or medical boards, ADA or Section 504 complaints with the HHS Office for Civil Rights or DOJ, or request prior authorization exceptions supported by physician documentation.

• Contact disability rights organizations. Every state has a federally designated Protection and Advocacy system which may provide free legal advocacy.

Sometimes simply raising these legal obligations is enough to make a provider or insurer reconsider a rigid in-person policy, because it shifts the issue from automatic denial to requiring a legally defensible justification.