22 states have no telehealth payment parity law, so insurers reimburse virtual visits at 50-75% of in-person rates

As of November 2025, 22 U.S. states have no payment parity requirement for telehealth services, meaning private insurers in those states can -- and do -- reimburse virtual visits at substantially lower rates than equivalent in-person visits. In states without parity laws, insurers commonly pay 50-75% of the in-person rate for telehealth visits, even when the clinical service provided is identical. For a primary care physician billing a Level 3 E&M visit, this means collecting $50-70 for a telehealth visit versus $90-100 in person. For specialists, the gap is even wider. Five additional states have parity laws with significant caveats that allow insurers to negotiate lower rates in practice. This payment gap directly undermines telehealth adoption in the states that need it most. When a physician loses $30-40 per telehealth visit compared to seeing the same patient in the office, the rational economic decision is to require in-person visits. This is exactly what happens: practices in non-parity states schedule fewer telehealth appointments, maintain shorter telehealth hours, and are less likely to invest in telehealth infrastructure. The patients who suffer most are those who would benefit most from virtual care -- rural patients with long drive times, elderly patients with mobility limitations, and working parents who cannot take time off. The irony is that many of the 22 non-parity states are rural states with the greatest provider shortages, where telehealth could have the most impact. The structural reason this persists is that payment parity is a state-level insurance regulation, and state insurance commissioners and legislatures face aggressive lobbying from payers who prefer lower reimbursement rates. The insurance industry argues that telehealth visits are inherently less costly to deliver (no physical office overhead) and therefore should be reimbursed at lower rates. This argument ignores the reality that physician time, expertise, and liability are the same regardless of delivery modality, and that the overhead savings from telehealth are already captured by the practice, not the insurer.