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Reimbursement for telemedicine has been challenging and tends to be fragmented depending on type of care provided, patient location and type of medical care insurance. The Centers for Medicare and Medicaid Services historically had a narrow definition for telemedicine for purposes of reimbursement as requiring a two‐way, real‐time interactive communication between the provider and a patient at a distant site, but that is changing with expansive new regulations issued in 2019 that broaden the definition and potential for reimbursement [31]. While historically, payment was only provided for synchronous telemedicine visits, Medicare/Medicaid is expanding coverage to asynchronous visits (store‐and‐forward) and other types of telehealth, which may pave the way for private payers who often follow suit. One problem to consistent reimbursement is a lack of statewide policies that cover synchronous, asynchronous and remote patient monitoring services, and a lack of policies that dictate reimbursement of telehealth services at the same rate as similar care delivered in‐person [13].

Though standard and consistent reimbursement are critical for a successful telehealth program, other financial considerations need discussion. One of the primary patient benefits of telemedicine is the cost savings for travel, food and accommodation at the site of care, especially for patients from remote rural areas or from long distance (i.e., Hawaii, Alaska). This cost savings to patients may result in a willingness to pay out of pocket for telehealth if the patient total travel cost savings with telehealth are greater than the cost of in‐person care. Additionally, healthcare systems may be willing to subsidize telehealth as a mechanism for bringing more patients into their system and potentially increasing the volume of in‐person care [18]. Telehealth programs that provide consultation between specialists and community generalist providers have been shown to benefit patients and reduce cost [5]. In a study to understand the factors common to hospitals that offer telehealth, the authors found that in competitive markets, telehealth is a way to distinguish the hospital from others in the region. Another important result of this study, albeit not surprisingly, was that more hospitals adopted telehealth in states where private payers are required to reimburse telehealth services at the same rate as in‐person services [24].