Audio-Only Telehealth: A Lifeline for Pennsylvanians Without Broadband

Phone calls remain a critical — and contested — tool for reaching patients the internet can't.

The Case for the Plain Old Phone Call

When policymakers celebrate the telehealth revolution, they tend to picture a patient video-chatting with a physician from a well-lit home office. That picture leaves out a sizable slice of Pennsylvania. Rural counties — including parts of Centre County and stretches of the state's northern tier — still lack reliable broadband, and plenty of lower-income urban residents in Philadelphia and Allentown cannot afford the smartphones or data plans that video visits require. For those Pennsylvanians, the telephone is not a fallback. It is the only option.

Audio-only telehealth¹ — a simple phone call between clinician and patient — expanded sharply during the COVID-19 pandemic when federal and state regulators temporarily relaxed rules that had previously required a video component for reimbursement. Pennsylvania Medicaid, administered through the Department of Human Services ↗, moved to cover phone-based visits, and that coverage allowed patients to reach primary-care providers, behavioral health counselors, and prescription managers without leaving home and without a broadband connection.

The broadband gap is not evenly distributed. The CDC and other federal agencies have consistently documented that rural, elderly, and low-income populations lag in both internet access and device ownership. Pennsylvania's own geography amplifies the problem: the state combines a dense urban core with some of the most isolated rural terrain in the Northeast, and communities in counties like Lewistown's Mifflin County face access challenges that fibre-optic promises have not yet solved.

The policy tension is real, however. Insurers and some state regulators worry that audio-only visits are harder to document, raise fraud risk, and may not meet the clinical standard of a video encounter. The American Academy of Actuaries has flagged reimbursement parity² questions — whether a phone call should pay at the same rate as an equivalent in-person or video visit. Pennie ↗, Pennsylvania's ACA marketplace, does not itself set telehealth rules, but the plans it sells must comply with state and federal mandates that remain in flux.

The stakes for getting this right are high. Behavioral health care — therapy, medication-assisted treatment for opioid use disorder, psychiatric check-ins — is among the services most successfully delivered by phone, precisely because patients in crisis often cannot travel and may lack video capability. Cutting audio-only reimbursement to trim costs could quietly push those patients back to no care at all. That is a trade-off Pennsylvania's legislators and the Pennsylvania Insurance Department cannot afford to ignore.

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