What is the procedure for obtaining coverage for telehealth appointments with my doctor in California?

In California, your health plan is generally required to cover telehealth services to the same extent that it covers the same services delivered in person. Follow these steps to ensure your telehealth appointment is covered. Step 1: Contact Your Doctor's Office Call your doctor's office first. Confirm that they offer telehealth appointments for your specific medical needs and that they accept your insurance plan for these remote visits. Step 2: Review Your Health Plan Documents Locate your "Evidence of Coverage" or "Summary of Benefits" document, often available on your insurer's website. Search for terms like "telehealth" or "telemedicine" to understand your plan's specific rules, co-pays, and deductibles for these services. Step 3: Call Your Insurance Provider Use the member services phone number on your insurance card to call your provider. Ask them directly if telehealth visits with your specific doctor are covered and if you need any pre-authorization. Record the date of the call and the name of the representative for your records. Step 4: Schedule and Attend Your Appointment Once you confirm coverage, schedule the telehealth visit. After the appointment, your insurance plan will send you an Explanation of Benefits (EOB) statement by mail or email. Step 5: Check Your Explanation of Benefits (EOB) Review the EOB carefully. It will show how much your plan paid and what you owe. Make sure the charges match your understanding of your co-pay or deductible for a telehealth visit. If you see a denial or an incorrect charge, contact your insurer immediately to inquire or begin an appeal. Important details and nuances: Under California law, health plans cannot limit coverage for telehealth based on the platform used, meaning they must cover a visit whether it's through their proprietary app or your doctor's own video system. This applies to both physical and mental health services. Your normal co-pays, co-insurance, and deductibles will still apply. Warnings and limitations: Your doctor must agree that telehealth is clinically appropriate for your situation. Not all medical issues can be handled remotely. If your claim is denied, you have a right to file a formal grievance or appeal with your health plan. This is general information and does not constitute legal advice. For complex situations, such as a persistent denial of coverage or billing disputes, you should consult with a qualified California attorney.