We've been arguing about the wrong things for years. Should a video visit pay the same as an in-person one? Do we need a new code for a quick e-consult? These debates feel important. They're noise. The real problem? Much bigger. And almost nobody in benefits is talking about it.
Telehealth billing today is a retrofit. We took a payment system built for face-to-face, fee-for-service medicine and dropped a video call into it. The result? Paying for efficient care with an old, wasteful model. That mismatch quietly kills the value virtual care was supposed to deliver.
The 90-Day Float Nobody Mentions
The real issue isn't the code. It's when and how the money moves. In a typical setup, a telehealth claim gets paid 30 to 90 days later—same as an in-person visit. From a benefits admin standpoint, that's a copy-paste of a broken process.
And here's what rarely gets discussed: that billing cycle rewards inefficiency. Health systems earn on RVUs. Whether care happens in a $500/min OR or a $2/min Zoom, payment stays the same if the CPT matches. The system pockets the difference—a hidden subsidy for legacy infrastructure.
This is why many large health systems haven't fully embraced low-cost telehealth. They're not slow. They're rational—they don't want to cannibalize profitable in-person visits. The billing structure doesn't reward efficiency. It rewards the appearance of a visit.
Stop Billing for the Visit. Start Billing for the Outcome.
The fix is obvious but needs a different mindset. Stop thinking of a telehealth visit as a billable event. Think of it as a behavioral trigger—a free, zero-co-pay entry point into a smarter system. The real revenue isn't the claim. It's everything that happens next.
Here's a concrete example from a model already doing this: the WellthCare ecosystem. WellthCare, the first Health-to-Wealth Benefit System, turns telehealth into a behavioral trigger that rewards prevention with store dollars and retirement contributions while lowering employer claims.
How a Health-to-Wealth System "Bills" for Telehealth
- Make the visit free. The $0 co-pay virtual consult is the Trojan horse. The low marginal cost of a video platform is trivial compared to a physical visit. So absorb it. The real value is downstream.
- The "bill" becomes the data. That 15-minute conversation generates a personalized plan of care. It triggers a preventive action—a lab test, a scan, a medication refill. The system tracks that action and rewards the employee with real, spendable dollars or a retirement deposit. The "payment" is not a claim; it's a behavioral incentive that proves the system is working.
- Capture waste, not revenue. Imagine a telehealth visit for a sinus infection. Old model: $100 claim, plus a PBM spread on the prescription—total $120, with 20-25% waste. Aligned model: the visit is free, the prescription goes through an integrated pharmacy at cost+10%, and the margin that used to be waste now funds the employee's store dollars and pension. The telehealth visit becomes a profit center—not by charging more, but by eliminating the friction around it.
Three Questions Every Benefits Leader Should Ask Right Now
If you want to fix your telehealth billing, stop obsessing over modifiers. Ask these three things instead:
- Is your telehealth contract a waste capture or a cost center? If you're paying $100 for a $30 virtual visit, you're subsidizing fee-for-service. Renegotiate to a flat per-member-per-month fee for unlimited virtual care. Then focus on how that care redirects spending.
- Are you using telehealth to feed a readiness index? The real ROI isn't lower claim costs per visit. It's the data. In a modern system, each telehealth interaction feeds a proprietary Readiness Index that proves to the employer: "Your population is X% ready for self-funding. Here's the projected $3M savings." The visit is an investment in generating that proof.
- Have you switched your billing unit from a code to a wallet? The future of billing for effective care isn't a CPT code. It's the employee's wallet—store dollars and pension contributions that reward healthy behavior. And the employer's wallet—savings from vastly reduced total cost of care.
The Bottom Line
The debate about telehealth billing codes is a distraction. It keeps us fiddling with a broken system instead of building a better one.
The real move is to go upstream. The "bill" for a telehealth visit in an aligned ecosystem isn't a claim. It's the value of preventing a future heart attack. It's the data that powers a smarter health plan. It's the economic surplus that becomes a retirement contribution.
Stop trying to bill for the video call. Start building the system that bills for the outcome.