Because of my career-long focus and unique experience in the combination of sleep surgery and sleep medicine, patients from around the country or other countries often reach out for an evaluation or for surgery. Because of the logistical challenges and costs of in-person visits, I have offered video consults for many years. These remote evaluations have allowed me to discuss their cases and either recommend treatments or plan surgery so that they can make fewer trips to receive care.

Pros and cons of telemedicine visits for sleep surgery

Telemedicine and telehealth are here to stay. The pandemic encouraged the adoption and its Los Angeles is well-known for its vehicle traffic and lengthy travel times, making telemedicine particularly attractive for my patients. Who can argue with a 20-30 minute visit over a platform like Zoom instead of the 2 hours and the hassles of an in-person visit, considering driving, parking, and waiting that adds to the time I can spend with a patient?

Telemedicine visits have the important and real limitation of the inability to perform a complete physical examination, but we have overcome these challenges for most patients because the detailed physical examination often is not entirely necessary to make initial recommendations. In some cases, we can make decisions about surgery without this detailed in-person evaluation, sometimes just reviewing records that patients already have. For example, patients can send their completed New Patient Forms, sleep study reports, and even the video recordings of evaluations like an awake fiberoptic endoscopy or drug-induced sleep endoscopy.

Does my insurance cover a telemedicine visit?

In many cases, the answer is yes. The COVID-19 pandemic has accelerated the development and use of telemedicine and telehealth. There was the obvious effect of the pandemic in restricting in-person medical visits, forcing us to learn more about what can be done using telemedicine. Just as important were multiple new laws and regulations enabled patients to have their health care coverage pay for the costs of a telemedicine visit with their medical provider. While telemedicine visits had been covered by some payors in the past, the level of coverage had been substantially lower, preventing wide adoption.

For patients interested in a telemedicine evaluation, the first question is whether this will be covered by their medical insurance. The Federation of State Medical Boards has summarized the requirements for performing telemedicine and telehealth visits in response to COVID-19. Of note, these rules are not limited to visits for COVID-19 care; they apply to all medical provider visits and, funnily enough, are based on the state where the patient is physically located at the time of the telemedicine visit (not necessarily their state of residence). Because the rules can be complicated, we actually have our hospital team review each case to make sure the care is billable to a patient’s medical insurance.

What if my insurance does not cover a visit?

If your health care coverage does not cover the costs of your visit, you can travel to California (so that you are physically in the state) for a telemedicine or in-person visit. For many people this is not straightforward. They can obtain a video consult with me that is not covered by insurance. It would involve the same complete review of your records and discussion, but you would pay for this yourself. The one difference between these consults is that they are not considered formal medical evaluation. I would not be able to prescribe medications or start treatments directly, but I can provide suggestions about your care or prepare our team for you when you can come for evaluation and treatment. It has many similarities to a medical evaluation, and I have performed over 100 of these for patients in the United States and abroad.

In short, the COVID-19 pandemic has encouraged people to rethink how they receive and deliver care. Our job is to make sure we provide high-quality care in the most effective and efficient way possible. Telemedicine is part of that solution. If you have any questions about a telemedicine visit or video consult, please do not hesitate to contact me.

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