The COVID-19 pandemic has fundamentally changed how patients access care through their insurance benefits, particularly at-risk populations like seniors and those with underlying health conditions. Many of these members are unable to receive eye exams and other essential in-office eye care services, as social distancing has become the "new normal."

Fortunately, telemedicine technology has been rapidly advancing to deliver eye exams and other critical care at home – and its popularity is unlikely to wane in the wake of the pandemic.

However, many members may not understand that their vision benefits can afford them ocular telemedicine options, with some foregoing critical eye care altogether. To add, not all ocular telemedicine options are created equal—some will be more appropriate than others, depending on the population's particular needs.

Benefit brokers and managers must truly understand the opportunities and limitations of ocular telemedicine to be able to educate members on the true value of their vision benefits in the challenging environment presented by the pandemic, especially with open enrollment season right around the corner.

Telemedicine use is growing and likely here to stay

Originally, telemedicine was used to provide consultations at home that would typically require frequent or regularly recurring in-office patient visits, such as therapy. However, in recent years, national, state and private health policies have been expanding the approval and reimbursement of remote technologies that would traditionally require in-person provider office visits. In fact, 223 state telemedicine bills were introduced in 2019, particularly in states with significant rural areas and underserved residents.

The COVID-19 pandemic has sped this process up, and telemedicine approvals have grown exponentially in just a few months in a wide range of services, including eye care, as patients have been wary of in-person care that requires human contact. In response to COVID-19, the Center for Medicare and Medicaid Services broadened access to Medicare to allow a wider range of services to be covered—and this expansion may last long after the pandemic.

Ocular telemedicine is a partner, not a replacement

The potential for ocular telemedicine is great—it serves to improve access, lower costs, ensure quality care for patients and provide greater efficiency for patients, care providers and insurers alike. However, current technology has not yet been able to match the imaging capabilities of in-office exams. Therefore, ocular telemedicine, in its current stage of development, cannot entirely replace the value of in-office visits with eye care professionals. Rather, its best used to enhance in-office visits by supporting ongoing care and strengthening the relationship between eye care professionals and their patients.

For instance, in the case of a patient with a degenerative vision condition, such as age-related macular degeneration, patients can monitor their eye health at home and regularly share images of their eyes with their eye care professional to determine when emergency care is required, so that patients only need to schedule in-office visits when absolutely necessary.

Ocular telemedicine limitations and considerations

Even though telemedicine is rapidly expanding, ocular telemedicine still has many state-by-state limitations on the type of eye care that can be reimbursed by insurers. Further, providers and insurers are still grappling with concerns about privacy, security and validity of the technologies, imaging quality and even legal licensure requirements across state medical boards.

In response, insurers' approaches to ocular telemedicine reimbursement are continually evolving as members' needs and opportunities for better technology arise.

A few core principles for a reimbursable ocular telemedicine visit at this moment in time include:

The technology must authenticate the location and identity of the requesting patient.
The technology must disclose and validate the identity and appropriate training of the professional rendering care.
The professional providing care must be appropriately licensed and the telemedicine services must be approved by both the jurisdiction extending the professional license and the jurisdiction in which the patient is resident.
The telemedicine service organization and professional must have policies and procedures assessing patient satisfaction, safety, privacy and security of the medical record consistent with federal and state regulations.

Eye Exams can serve as a window to health

Despite strict requirements for ocular telemedicine reimbursement in some areas, it is still possible to receive an eye exam via digital technologies. Particularly for seniors or those with underlying health conditions, telemedicine eye exams are widely available and can provide a wealth of information into overall health.

For instance, in the case of a senior experiencing eye pain or discharge, emergency eye exams can be provided in residence via technology-enabled, real-time video and audio communication.

Because people with vision problems are more likely than those with good vision to have diabetes, poor hearing, heart problems, high blood pressure, strokes, as well as an increased risk for falls, injury and depression, the concern is that delaying care may exacerbate existing conditions and lead to overall deterioration of health. Rather than delay care because of barriers stemming from the pandemic, an eye exam can also be one of the easiest and most cost-effective way to evaluate eye health, identify vision problems and detect close to 30 chronic health conditions.

Although telemedicine has made impressive progress in the past few years and months, it still has a long way to go. Until that time, it is best used in cases of emergencies or as a supplement to in-person care. Brokers and benefit managers can serve as helpful connectors between eye care professionals and members on the value of vision benefits for understanding when and how to use ocular telemedicine.

Dr. Mark Ruchman is the chief medical officer at Versant Health, a managed vision care company focused on creating an integrated and seamless experience for health plans, members and eye care professionals across the total eye health value chain.

Read more:

Instant Insights /

Telemedicine and vision benefits: What you need to know

More From HR Executive

Related Stories

Recommended For You