Insights

Getting Telemedicine in Texas: Laws, Rules, & Where to Find

Alexis Bryan07 Jul 2021

Telemedicine has been on the rise for the past few years because of the speed and flexibility to get access to basic health diagnoses from the convenience of your home. Through telemedicine, you can diagnose a cold, rash, mental or more. In Texas, it can be one of the most affordable options if you have simple care needs, but not all things can be diagnosed via telemedicine.

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What is Telemedicine

Telemedicine increases patient access to physicians and other healthcare providers via an online platform. You can get in touch with your doctor from miles away as opposed to driving to their office and waiting your turn for a 15-minute appointment. Telemedicine is useful for asking questions about symptoms, obtaining doctor’s notes, and refilling prescriptions. It is meant to optimize provider resources, not replace in-person care. 

Telemedicine in Texas

In Texas, telemedicine providers are held to the same standards of care for remote services as in-person visits. Currently, you do not need to attend an in-person physician appointment before establishing a relationship with a provider, under Texas state law. 

Providers include healthcare professionals who are licensed to practice medicine in Texas and those acting under physician delegation. If you are going to receive ongoing remote care, you must attend one in-person appointment per year.

Benefits of Telemedicine & Telehealth

There are many reasons people are choosing telemedicine in Texas and also across the U.S. Before the COVID-19 pandemic, 43% of health centers offered telemedicine or telehealth services. Now 95% of health centers report using long-distance virtual care services. The use of telemedicine isn’t likely to slow down for basic care needs so let’s take a closer look at the biggest benefits of using this type of service.

Telemedicine is convenient

When you aren’t feeling well, the last thing you want to do is leave your bed to sit in a doctor’s office while you wait for your provider. Telemedicine allows you to get a physician’s care with a simple video call without leaving your home.

Telemedicine Can Be Quick

Going to the doctor is a time-consuming endeavor. Taking off from work for a sore throat can sound trivial, but with telemedicine, it is possible to speak with your doctor during your lunch break. No more wasting time or money going to and from your doctor’s office.

Telemedicine is Accessible

Telemedicine in Texas is essential to the health of rural populations. A quarter of the population of Texas lives in rural areas making it difficult to access health services. There may not be adequate transportation to points of care, or a general shortage of specialty providers to get the care you need. Telemedicine in Texas works to close this gap in access to care by helping people seek a professional’s advice without the commute.

Telemedicine is Typically Affordable

Additionally, telemedicine can act as a gatekeeper for more expensive services. Before traveling to the nearest physician for a service you may not even need, telemedicine providers can recommend the best course of action depending on your symptoms.

Most telemedicine visits are less expensive than a normal doctor’s appointment anyway. Below is a chart for average costs (including estimated prescription drug costs) of telemedicine appointments by health concern.

Average Cost of a Telemedicine Visit, by Health Concern

ConcernTelemedicine (on average, via GoodRx)
Acne$61
Acute Respiratory Infection $79
Birth Control$32
Cold Sore$21
Erectile Dysfunction$60
Hair Loss$66

When to use Telemedicine vs. When to go to the Clinic

Telemedicine is a great option for when you might be contagious with a basic virus or other illness that can be diagnosed remotely. Staying home protects other patients, and your doctor as well, while they evaluate your symptoms. If you are experiencing life-threatening symptoms, the emergency room is always the answer. 

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From a poll of 23,913 U.S. consumers conducted this month by Branded Research, we determined when people are more likely to use telemedicine instead of going to an in-person clinic.

Common Reasons for Using Telemedicine Instead of Going to a Clinic

When are you most likely to use telemedicine rather than going into an in-person clinic?

% Total

For mild illness

37%

For a consultation

22%

For prescriptions

19%

For mental health therapy

10%

For serious illness

5%

To see a specialist

4%

For other therapies like speech or physical therapy

1%

Patient Eligibility for Telemedicine

Eligibility could depend on what insurance you have if you’re looking for it to be covered, or it could vary by healthcare provider. There are three main requirements for telemedicine eligibility in Texas:

  1. A physician must determine that a physical examination is not necessary
  2. The patient must provide written or verbal consent to receive virtual care
  3. If the patient is being reimbursed through Medicaid, they must be seeing a provider at an eligible site

Telemedicine vs Telehealth

Both telemedicine and telehealth use advanced telecommunications technology to provide patient care, but telemedicine in Texas is distinct from telehealth. While people may use these terms interchangeably, Senate Bill 1107 passed in 2017 changed the state law regarding the definition of telemedicine. This amendment loosened two limitations:

  1. Telemedicine now includes the use of telephones for telemedicine
  2. Health professionals providing health services under the supervision of a physician who is licensed in Texas are able to initiate telemedicine

Telehealth refers to any other remote health service provided by a licensed or certified practitioner that does not require clinical assessment, diagnosis, or treatment in Texas. It is a broader term for any electronic health service or communication.

Telemedicine Parity Law

Depending on the type of insurance you have, there are differing reimbursement regulations for providers. The state of Texas has a telemedicine parity law requiring private insurance companies, state employee health plans, and Medicaid to cover long-distance patient care.

Private Payer and State Employee Plans

Texas insurance code requires private payers to reimburse for telemedicine services. This does not include any care received through email. Private payers determine their own reimbursement rates to providers, but it is around the same as the equivalent in-person service.

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Medicaid in Texas

Medicaid reimburses the same amount for equivalent telemedicine and in-person services. Patients must originate at established medical sites, mental health facilities, or state-supported living centers. Care over the phone or email is also not covered. As of right now, telemedicine in Texas is reimbursed by Medicaid for the following services:

  • Consultations
  • Outpatient visits
  • Psychiatric diagnostic interviews
  • Pharmacologic management
  • Psychotherapy
  • Diabetes management
  • Hypertension management
  • Home-based patient monitoring

There are some limitations to telemedicine services covered by Texas Medicaid. If you can reasonably access an in-person visit, Medicaid is not required to cover the care. Additionally, Texas law does not specify the types of providers eligible for reimbursement, but Medicaid does. The eligible providers include:

  • Physicians
  • Nurse Practitioner
  • Physician Assistant
  • Certified Nurse Midwife
  • Licensed marriage and family therapists, clinical social workers, professional counselors
  • Psychologist
  • Licensed dieticians and nutrition specialists

Where to Access Telemedicine In Texas

To get started using Telemedicine in Texas, first ask your current provider if they offer virtual services. If not, here is a list of a few telemedicine providers across Texas that you might find to be the right fit for you:

Telemedicine in Texas Frequently Asked Questions (FAQs)

States have varying requirements and laws regarding telemedicine services and reimbursements. It is important to be familiar with what type of care you can and can’t receive remotely to choose the best type of health coverage for your lifestyle.

Can I get prescriptions via Telemedicine?

Licensed telemedicine providers in Texas, and across the nation, can prescribe medications without an in-person consultation. This makes the process a lot quicker and easier, especially when you have recently run out of an important prescription. Telemedicine providers can help you get birth control, prescribe medications like Tamiflu, and refill other prescriptions.

Keep in mind, doctors cannot determine the correct antibiotics for many infections or provide any type of medicine that first requires a blood test, like for HIV.

How is my privacy protected?

You may be concerned about sharing important and private information over the computer with your healthcare provider. The federal Health Insurance Portability and Accountability (HIPAA) law established standards to protect patients’ data from being shared without their knowledge. 

Check with your doctor to see if they are using a HIPAA-compliant platform to ensure your privacy. Additionally, the COVID-19 pandemic has created a unique circumstance and has allowed the exception of certain regulations.

Who is telemedicine best for?

Telemedicine is most useful for people who are busy and do not have the time to take off work to sit in a waiting room. It is a convenient option for anyone who lives far from a provider or simply does not want to waste time on a simple health concern. 

What does Store-and-Forward mean?

Store-and-forward refers to transferring health data online. This includes any information sent electronically to a distant provider like medical history, lab reports, and images/videos. In Texas, Medicaid covers store-and-forward services but private payers are not required to.

Bottom Line

People are busy and life is unpredictable, but our health is still important. For times when you are in a crunch and can’t get to a doctor, telemedicine is a way to get remote medical care. With the stay-at-home orders during the pandemic, Telemedicine has become a common option in Texas and continues to gain popularity.

Unfortunately, sometimes your health concern can not be solved virtually and may require blood work or a physical. Mira is working to eliminate the waiting room. With plans as low as $45 per month, Mira offers access to same-day lab tests, $99 urgent care, and 80% off prescription drugs. Sign up now and get coverage as quickly as today!