Virtual Care Creates New Coverage Challenges for Healthcare Companies
New York, Tuesday, 30 September 2025.
The emergence of virtual care has brought about complex coverage and reimbursement issues for healthcare firms, necessitating strategic adaptations to ensure patient access and care continuity.
The Evolution of Virtual Care and Its Challenges
The rise of virtual care, accelerated by the COVID-19 pandemic, has solidified telehealth as a crucial component of the healthcare system. With its growth, however, comes a host of complexities, particularly in terms of insurance coverage and regulatory compliance. The integration of digital health platforms into areas such as mental health, weight loss, and pharmacy benefit management has intensified liabilities and increased regulatory scrutiny [1].
Regulatory and Compliance Obstacles
Virtual care companies often face a labyrinth of state-specific regulations, including medical malpractice limits and licensing requirements. Telehealth providers must navigate these intricacies while also ensuring compliance with data privacy laws. Many startups struggle to adhere to these regulations due to limited budgets and a lack of specialized guidance, resulting in potential coverage gaps [1].
Insurance Coverage Complexities
Telehealth services have removed physical barriers to care but introduced new insurance challenges. Managed care errors and omissions (E&O) exposures are rarely covered under standard liability policies, leaving healthcare companies to address these gaps. Comprehensive coverage requires aligning carriers across coverage lines to prevent issues when claims arise [1].
The Impact of Telehealth on Patient Access
Telehealth has significantly increased patient access to healthcare services. As of 2024, 95% of HRSA-funded health centers utilized telehealth for primary care delivery, and 88% of physicians acknowledged its role in enhancing access for patients unable to visit in person [2]. Despite these benefits, the ‘telehealth cliff’ threatens to reduce access if Congress does not extend COVID-era waivers by October 1, 2025 [3].
The Future of Virtual Care and Insurance Alignment
Looking ahead, the virtual healthcare market shows no signs of slowing down. It demands expertise and coordination to manage the complex interactions between technology and care delivery. Healthcare organizations must develop cohesive plans that anticipate blended claims and ensure that insurance policies reflect the multifaceted nature of digital health services [1].