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Audio-only Telehealth

Written by Dr. Rieka Yu
Published on January 22, 2024
Research Highlights

MO is one of 29 states that do not require private insurance to cover audio-only telehealth.


People of color and individuals with low incomes are the most reliant on audio-only telehealth.


There is little research on the clinical and monetary effects of audio-only telehealth.

Missouri does not require coverage of audio-only telehealth services.

In MO, telehealth is defined as healthcare services that use information and communication technologies but does not include audio-only technology (RsMO 191.1145).


Forty-three states, including MO, and D.C. have Medicaid programs that reimburse audio-only telehealth with limitations (Public Health Institute 2023). Twenty-one states, not including MO, require private insurance to cover audio-only telehealth (The Commonwealth Fund 2021; Figure 1).


Different demographics rely on audio-only telehealth.

Audio-only telehealth is more likely to be used by (U.S. Department of Health and Human Services (DHHS) 2022):

  • People without a high school diploma
  • Adults age 65+
  • Latino, Asian, and Black individuals


Video telehealth is more likely to be used by (U.S. DHHS 2022):

  • Young adults
  • Individuals earning over $100,000
  • People with private insurance
  • White individuals


Twenty percent of Missourians and 61% of rural Missourians do not have high speed internet (Missouri Foundation for Health 2020).


One national study shows that removing access to audio-only telehealth would lead to the largest reduction of access to healthcare for Hispanic individuals, followed by non-Hispanic Black individuals (Kleinman & Sanches 2022). Removing access to audio-only telehealth would disproportionally affect individuals age 80+, people with incomes less than $25,000, the uninsured, and people with health care through the Veterans Affair, Indian Health Service, Medicare, and Medicaid.


There is very little research on the cost-effectiveness of audio-only telehealth.

A review of the United Kingdom, Australia, Canada, and the U.S. found that for the management of an established diagnosis, there is no difference in clinical effectiveness, patient satisfaction, and cost-effectiveness between audio-only and video telehealth (Byambasuren et al. 2023). For the care of chronic conditions such as renal disease or diabetes, there was no difference between audio-only, in-person, and hybrid care (Moran et al. 2022)


When adding audio-only telehealth to the usual care for depression, patients reported improved anxiety, access to support and advice, satisfaction, and self-management (Salisbury et al. 2016).


When using audio-only telehealth for prenatal visits, patients had positive opinions about using audio-only telehealth and reported less time away from work, resulting in less lost wages (Holcomb et al. 2020). Audio-only visits were more likely than in-person visits to be completed as scheduled. However, wait times were longer for audio-only visits compared to in-person visits.


Figure 1. States that require private insurance to cover audio-only telehealth services. Map adapted from The Commonwealth Fund.



Byambasuren O, Greenwood H, Bakhit M, Atkins T, Clark J, Scoot AM, & Glasziou P. (2023). Comparison of Telephone and Video Telehealth Consultations: Systematic Review. Journal of Medical Internet Research. 25, e49942. https://www.jmir.org/2023/1/e49942/PDF.

Centers for Medicaid & Medicare Services. (2023). Telehealth for providers: what you need to know. https://www.cms.gov/files/document/telehealth-toolkit-providers.pdf.

The Commonwealth Fund. (2021). States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations. https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/states-actions-expand-telemedicine-access-covid-19.

Holcomb D, Faucher MA, Bouzid J, Quit-Bouzid M, Nelson D,B, & Duryea E. (2020). Patient Perspectives on Audio-Only Virtual Prenatal Visits Amidst the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic. Obstetrics & Gyencology. 136 (2), 317-322. https://journals.lww.com/greenjournal/.

Kleinman RA, & Sanches M. (2022). Impacts of Eliminating Audio-Only Care on Disparities in Telehealth Accessibility. Journal of General Internal Medicine. 37(15), 4021-4023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999992/pdf/11606_2022_Article_7570.pdf.

Missouri Foundation for Health. (2020). Health Policy Solutions: Telehealth. https://mffh.org/wp-content/uploads/2020/08/Telehealth.pdf.

Moran B, Frazier T, Brown LS, Case M, Polineni S, & Roy L. (2022). A Review of the Effectiveness of Audio-Only Telemedicine for Chronic Disease Management. Telemedicine and e-Health. 28(9). https://www.liebertpub.com/doi/epub/10.1089/tmj.2021.0285.

Mo. Revisor § 191.1145 (2018). https://revisor.mo.gov/.

Public Health Institute. (2023). State Telehealth Laws and Medicaid Program Policies. https://www.phi.org/wp-content/uploads/2023/10/Fall2023_ExecutiveSummaryfinal.pdf.

Salisbury C, O’Cathain A, Edwards L, Thomas C, Gaunt D, Hollinghurst S, Nicholl J, Large S, Yardley L, Lewis G, Foster A, Garner K, Horspool K, Man M, Rogers A, Pope C, Dixon P, & Montgomery AA. (2016). Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomized controlled trial of a complex intervention. Lancet Psychiatry. 3, 515-525. https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)00083-3.pdf.

U.S. Department of Health and Human Services. (2022). National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. https://aspe.hhs.gov/sites/.

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