Yes, you can use telehealth through your healthcare benefits. And you probably should. Since the pandemic, telehealth has gone from an emergency stopgap to a mainstream, often preferred, way to get care. It's now a core part of preventive health strategies that forward-thinking benefits platforms (like those built on a Health-to-Wealth principle) actively promote. WellthCare is the first Health-to-Wealth Benefit System, rewarding verified preventive care, including telehealth visits, with Store dollars and automatic retirement contributions. Understanding how it's billed helps you use it without surprise costs.
How Telehealth Gets Billed Through Insurance
Telehealth visits get billed like an in-person office visit, but with a few twists that can change what you pay out of pocket. Your cost depends on three things: your plan design, the type of provider, and the purpose of the visit.
1. Coverage and Cost-Sharing
Most employer-sponsored plans cover telehealth for a wide range of services: primary care, mental health, dermatology, chronic condition management. What you pay depends on your plan's copay, coinsurance, and deductible.
- $0 Co-Pay Plans: Some modern benefit systems, especially those focused on prevention-first care, offer $0 co-pay telehealth as a first-line service. It removes financial barriers and catches small issues before they blow up into costly claims.
- Standard Plans: More traditional plans may charge a specific telehealth copay (say, $10–$50) or put the visit toward your deductible and coinsurance (e.g., you pay 20% after the deductible is met). The telehealth copay is usually lower than an in-person one, but not always. Some states require insurers to charge the same copay or coinsurance for telehealth as for in-person care, and many plans do this even where no law requires it, so check your plan documents before you assume a lower price.
2. The Billing Codes: CPT Codes and Modifiers
Providers use CPT codes to bill for telehealth. Common ones are 99202-99215 (office visits) with modifier 95 for synchronous audio-video telemedicine, plus a place-of-service code (02, or 10 when the patient is at home). Getting these codes right keeps claims clean and prevents denials.
3. In-Network vs. Out-of-Network
To get the most out of your benefit and keep costs down, stick with providers in your plan's network. Many insurers team up with national telehealth platforms (Teladoc, Amwell, MDLIVE) or have their own services. Going out-of-network for telehealth usually means higher costs, or no coverage at all.
4. Audio-Only Visits Are Coded Differently
Some telehealth happens by phone instead of video. A phone appointment with your doctor is audio-only telehealth, and it follows its own billing path. Since 2022, audio-only services use modifier 93, and the AMA added a dedicated set of audio-only CPT codes, 98008-98015. The older telephone-visit codes 99441-99443 were retired on January 1, 2025. Coverage for phone visits varies more than coverage for video: commercial plans, self-funded plans, and Medicare Advantage all set their own rules, and some pay less, or nothing, for audio-only. If your plan defaults to video but you need a phone visit, ask how it will be billed before you book.
How Advanced Benefits Ecosystems Integrate and Bill Telehealth
Newer benefits platforms treat telehealth as more than a convenience. They see it as a strategic tool for better health and financial results. In a system like WellthCare, telehealth is the main entry point into a Health-to-Wealth Operating System. Billing and value differ in a few ways:
- Frontline, $0 Co-Pay Access: Telehealth is the first line of defense. Employees use it before filing claims under their major medical plan, whether a traditional carrier plan or a self-funded plan. That cuts overall claims and lowers costs for the employer.
- Integrated into a Personalized Plan of Care: Telehealth visits often start with an AI health assessment and are part of a custom preventive care plan. Completing these visits can earn you incentives.
- Linked to Incentives and Wealth Building: In a true Health-to-Wealth model, verified preventive telehealth triggers automatic rewards. Completing a recommended screening earns Store dollars, and employer savings fund automatic retirement contributions that grow over time, turning health actions into wealth.
- Automated Billing & Compliance: A patent-pending technology platform handles the backend. It verifies the visit, keeps ERISA/HIPAA/ACA-compliant records, and automatically funds incentives. No paperwork for employees or admin for employers.
How to Use Your Telehealth Benefit
- Review your SPD or benefits portal: Look for the "Telehealth" or "Telemedicine" section. Note any required platforms and the exact copay or coinsurance.
- Verify network status: Before you book, make sure the provider or platform is in-network.
- Ask about billing: When scheduling, ask how they'll bill and what you'll owe.
- Use it for prevention: Telehealth is great for annual check-ins, minor issues, mental health, and prescription management. Catching things early saves hassle and money.
- Understand the bigger picture: If your employer offers a modern benefits system, jump in. Using included telehealth might be your first step toward better health, financial rewards, and lower costs for your company, all at once.