Audio-Only Telehealth: A Lifeline for Patients in Areas with Limited Broadband Access

Many places in the U.S. still have trouble with healthcare access because they don’t have good broadband internet. A 2021 report from the Federal Communications Commission (FCC) said over 14 million Americans lack broadband. People in rural areas are 16% less likely to have broadband than those in cities. Almost 44% of households making less than $30,000 a year don’t have broadband at home. Without broadband, patients can’t easily join video telehealth appointments. This makes phone-based, audio-only telehealth visits very important for these groups.

Montana’s House Bill 43, signed in 2021, shows how laws can help telehealth access. The bill made telehealth services bigger by removing past limits. Before, telehealth was only for patients who had seen their provider in person or lived in certain places. Now, HB43 allows audio-only telehealth visits for patients in rural and frontier areas. The bill recognizes that many still find it hard to get broadband. Governor Greg Gianforte said these changes are “transforming how care is delivered,” especially in rural Montana.

California’s Medicaid program, Medi-Cal, serves over 14.6 million low-income or disabled people. Many Medi-Cal patients cannot always use video visits. So, California pays providers the same amount for audio-only visits. This helps keep care going. From 2024, providers will have to offer live video options, but audio-only visits stay important. This is especially true in places with bad internet or for patients who find digital tools hard to use. Mei Wa Kwong from the Center for Connected Health Policy points out that audio-only telehealth matters a lot for older adults and non-English speakers. These groups often rely on phone visits instead of video.

Still, rural states like West Virginia face problems. West Virginia has one of the lowest broadband access rates in the country and not enough healthcare workers. Yet, its Medicaid program does not pay for audio-only telehealth visits now. This creates a big barrier for rural patients who cannot use video telehealth. Experts suggest changes in policy, such as expanding Medicaid coverage and improving broadband.

Virginia shows more rural healthcare challenges. About 30% of Virginians live where maternity care is limited or missing. Many pregnant women must travel far for care. A House committee on rural health suggests insurers pay for audio-only telehealth to help people without broadband. Chair Rodney Willett calls audio-only care “a lifeline,” especially for older people or those without computers.

Benefits of Audio-Only Telehealth

• Reduces travel barriers: People in rural areas often have to travel far to see a doctor. Audio-only telehealth lets them have visits from home. This saves time and money.
• Supports chronic disease management: Telehealth helps patients follow their treatment plans and keep appointments. Studies in West Virginia showed telehealth improved continuity of care by up to 20%, helping with long-term illnesses.
• Supports mental health care: Audio-only telehealth is important for delivering behavioral health services. This is especially true in states like West Virginia where mental illness rates are high.
• Keeps healthcare access during emergencies: During COVID-19, audio-only telehealth allowed care to continue while reducing in-person visits. Across the U.S., audio-only calls made up a big part of telehealth visits. In California’s low-income clinics, 1 in 5 primary care visits and 2 in 5 mental health visits were audio-only.
• Promotes healthcare equity: Audio-only telehealth removes technology and location barriers. It helps underserved groups get care more fairly.

Challenges and Limitations of Audio-Only Telehealth

• Quality of care concerns: Some people say that audio-only visits do not build the same patient-provider relationship as video or in-person visits. Some medical exams need to see or touch the patient, which audio cannot do.
• Privacy concerns: Telehealth workers must check patient identity carefully. They must make sure talks happen in private and secure places to protect health information and follow privacy laws.
• Policy and payment limits: Some insurance programs, including some Medicaid plans, do not pay equally for audio-only visits. This makes providers less likely to offer them.
• Risk of fraud: Audio-only telehealth needs close records and rules to prevent billing mistakes or fraud. Federal investigations found over $1 billion in losses connected to telemedicine scams.

Still, the American Medical Association (AMA) suggests using video visits when possible but supports audio-only visits for patients who cannot use video. They stress the need to document consent, check patient ID, and keep records to ensure good care and legal safety.

Policy Updates Supporting Audio-Only Telehealth

• The American Relief Act of 2025 extended telehealth rules, including audio-only visits for Medicare patients until March 31, 2025. This helps patients without broadband or video tools keep getting care.
• States like Ohio, Kentucky, and Tennessee require Medicaid and private insurance to cover audio-only telehealth the same as other visits. This supports rural healthcare.
• The Telehealth Access for Tribal Communities Act of 2025 protects audio-only telehealth for Medicare patients on tribal lands where broadband is poor. During the pandemic, Indian Health Service data showed 60% of telehealth visits were audio-only, showing the technology gap.
• Legislation like Montana’s HB43 and Virginia’s push for insurer coverage of audio-only telehealth show bipartisan agreement on its role in fixing healthcare access gaps.

These federal and state efforts help grow telehealth services and make sure patients don’t lose care because of tech limits.

Integrating AI and Automation for Audio-Only Telehealth Workflow Efficiency

Medical offices and IT teams can improve audio-only telehealth by making workflows better while keeping quality and following rules. Artificial intelligence (AI) and automation can help, even with just audio calls.

• Automated Call Routing and Scheduling: AI phone systems can remind patients about appointments, confirm if they will come, and send calls to the right provider or office. This cuts front desk work and helps patients get through faster.
• Voice Recognition and Documentation: AI that turns speech into text can take notes during audio visits. This keeps medical records accurate without extra work for the provider. It also helps with billing.
• Patient Verification and Consent: Automation can check patients’ identity by asking for multiple ID details or passcodes before calls start. Electronic consent forms can be part of call steps, making sure rules are followed.
• Clinical Decision Support: AI tools can help doctors by analyzing patient answers during calls. They can warn about risks or suggest what to do next. This helps keep good care even without seeing the patient.
• Call Quality Monitoring: AI can check call quality, spot privacy problems, and send alerts. This helps keep patient information safe and follow health privacy laws.
• Data Analytics for Telehealth Usage: Automated reports can show how many telehealth visits happen, who uses them, and patient results. This information helps with office decisions and policy work.

Some companies, like Simbo AI, offer AI tools that fit into audio-only telehealth. They make office jobs easier and help engage patients better. By automating tasks and notes, healthcare staff can spend more time on patient care.

Best Practices for Medical Practices Using Audio-Only Telehealth

• Follow HIPAA rules fully: Make sure all phone calls are secure. Check patient identity using more than one ID. Document patient consent for telehealth visits.
• Train staff on telehealth steps: Front desk workers, providers, and IT staff should learn how audio-only visits work and how to use supporting technology like AI.
• Tell patients about telehealth choices: Explain how audio-only telehealth works and what to expect during calls. This is important for patients less used to the technology.
• Use billing codes right: Getting paid for audio-only visits depends on correct coding and documentation. Stay updated on insurance rules and telehealth policies.
• Use AI and automation to lessen office work: Use technology for scheduling, patient checks, note-taking, and follow-ups. This makes things run smoother.
• Watch and review results: Use data to check access, patient satisfaction, and health results from audio-only telehealth. Change practices based on what you learn.

Audio-only telehealth is still an important way to give care to millions of Americans who don’t have many choices. Laws and clinical guidelines now support it more. With AI-based workflow tools, healthcare workers and managers can help make audio-only telehealth bigger and work better—especially in rural and underserved places where broadband is still hard to get.