Are Virtual Pediatrician Visits Worth the Cost?
Virtual care is all the rage these days, but before parents make it the go-to for their kids, they need to understand cost considerations—and when in-person visits are a must.
When you're the parent of a little one, it can seem like someone in your household is always sick. The colds, viruses, and other issues—along with regular well-child visits—can add up to...a lot of trips to the pediatrician. With all that back and forth, you might be wondering if virtual visits will save you time and money or if in-person visits are a must.
"The most important advice," says Dr. Delene Musielak, FACP, FAAP, founder and host of The Dr. Mom Show and a mother of triplets, "is that parents really need to communicate with their pediatrician's office. We are able to triage the problem or concern and recommend an in-person visit versus urgent care versus a virtual visit."
But first, you're not imagining it. Someone in your house might actually always—or at least often—be sick. What sounds like an exaggeration is backed by research. For about 50% of each year, kiddos under 5 tend to have viruses in their snot, according to a study in Clinical Infectious Diseases. That same study shows that a household with six kids can be plagued by illness for almost 90% of each year. Two-kid homes have illness about 50% of the year. And one-child households are under the weather 35% of the year. No wonder you're curious about virtual visits.
However, despite the uptick in overall telehealth usage in 2020, parents still appear to favor in-person visits for their kids. Appointment booking service Zocdoc reports that 89% of recent pediatrician bookings on the service have been for in-person appointments with just 11% for virtual pediatrician services. Zocdoc reports that virtual pediatrician appointments have remained between 10% to 15% for the entire pandemic.
Well-child visits should always be in-person
"Telemedicine has opened an amazing opportunity for great access to care," Musielak says. "However, it is still of the utmost importance that parents still take their children in-person for their well-child checks."
Well-child visits, also sometimes referred to as physicals, are crucial for tracking growth and development, discussing concerns about your child's health, and getting your child's scheduled vaccinations, according to the Centers for Disease Control and Prevention (CDC). Musielak says regular in-person checkups are also important for screening children for depression and anxiety.
Related: How to Select a Pediatrician
"During the pandemic, we have seen the number of checkups decrease," Musielak says, "which means kids are behind on their immunizations, their developmental milestones are not being monitored, and they are not being screened for hearing, vision, autism, etc. This is just to name a few items. Therefore, for physicals, parents should be taking their children for in-person visits."
Some sick visits can be done virtually
The good news is that when your kid isn't feeling great, you may not have to drag them off the cozy couch. "There are some cases when virtual visits can be utilized," Musielak says. "Some of these include some sick visits, such as cold or flu symptoms. In this case, telemedicine visits decrease the risk of exposure and spread. And physicians can just order any appropriate tests that are needed." Virtual visits can often also work well if a skin issue crops up, Musielak adds. If necessary, parents can simply send photos to their pediatrician.
Urgent care for one and done
Urgent care can be a great option if you know your child will need specific testing or screening, such as imaging. "Instead of having an in-person visit at the physician's office and then having to go to another location for an X-ray," Musielak says, "if a child is taken to urgent care from the get-go, that deletes another location." Not only does this reduce exposure to germs but it also saves time.
When it comes to saving money, virtual visits may run you the same amount, more, or even less (in some cases) than in-person appointments. It all depends on your health insurance.
At the start of the pandemic, many private insurance providers covered the cost of virtual visits, according to the Center for Connected Health Policy. Some insurers waived copays and covered the full cost of telehealth, while other insurance providers covered virtual visits at the same rate as they covered in-person appointments (sometimes through reimbursement). However, in early October 2020, various insurers began rolling back waivers and coverage on virtual visits, with some expiration dates falling in December and others in January. So, as with anything relating to health insurance, there's not a blanket answer.
If you're considering a virtual visit, you should check with your insurance provider on patient cost-sharing to avoid any surprise billing or getting stuck with a tab for which you were expecting to get reimbursed. But for quick reference, America's Health Insurance Plans (AHIP), a commercial health insurance trade group that has been tracking insurers' COVID-19 response, offers an alphabetical list. Just search for your insurance provider and review whether it is still waiving cost-sharing on virtual visits and any parameters you must follow, such as booking an in-network provider.
The bottom line
"The majority of insurances are covering virtual visits," Musielak says. "So at this point I feel the most important consideration is what type of visit will serve the family the best and be the safest."