Telemedicine has been utilized for over 40 years as a means of expanding real time care to patients as an alternative to face-to-face medical visits, but technological improvements to telecommunications have opened the doors for new forms of virtual clinical practice.1 Devices such as smartphones, tablets, and laptops have the potential for medical assessment and diagnosis to be conducted anytime, anywhere for the convenience of clinicians and patients alike. Many start-up companies have emerged to provide medical care to patients via telemedicine using a range of technologies, seeking to change healthcare access to an on-demand model with flexibility for both patients and practitioners.

Two of the most popular virtual services offer board-certified physicians 24 hours a day, seven days a week year-round for immediate patient care. Doctor on Demand connects patients via video and/or audio from smart devices, laptops or computers for up to 15 minutes for illnesses including infections (upper respiratory, urinary tract, yeast), fever, eczema, and allergies, as well as certain prescription refills. The physicians are not able to prescribe Schedule II, III, or IV drugs, medications that require close monitoring by a healthcare professional, or medications that require administration by a healthcare professional or require training for first time use.2 Similarly, MDLIVE allows patients to select a board certified physician, make an appointment or request immediate care, and connect with the doctor via online video or phone. MDLIVE also connects patients with mental health professionals to treat conditions such as anxiety, depression, post-traumatic stress disorder, and sleep disorders. Both services are designed to provide an alternative to urgent care centers and some emergency room (ER) visits, although they stress that any patient with a life-threatening condition that requires immediate care should seek treatment at their nearest ER. MDLIVE also emphasizes that the services provided should not replace primary care treatment for common or chronic conditions.3 While neither service currently accepts insurance, patient fees for Doctor on Demand are $40 per 15 minutes of consultation and $49 per session for MDLIVE (most sessions completed within 10–15 minutes, with the option for a longer visit if approved by the physician). This may be appealing to patients as an alternative to urgent care visits, as this cost may be lower than private insurance co-pays for these services in a physical medical office. 

While Doctor on Demand and MDLIVE’s models charge per virtual visit, HealthTap has adopted a subscription-based model in which members can access unlimited virtual consultations with physicians with the same 24/7, 365 days a year availability. HealthTap offers limited free services, including accurate and reliable medical news, tips, and information on a range of topics from expert physicians. For $99 a month (plus $10 for each additional family member), patients can subscribe to HealthTap Prime for unlimited virtual consultations, personalized health recommendations, unlimited access to health information on the website and app, and priority for answers from doctors using the anonymous question and answer service. The HealthTap concierge service also connects patients to their existing physicians for expanded medical treatment beyond immediate care utilized by the HealthTap Prime platform.  Medicare/Medicaid and private insurance do not currently reimburse patients for HealthTap services.4