Opinion: I'd never want a physician who wanted to "skype" me. LOL
There are guidelines for online visits, medicare does not pay for them but I'm pretty sure the guidelines are meant over a secure means of communications such as a chat environment that is on a secure server. I'm pretty sure SKYPE is not a valid means of patient care. Most of the carriers that are paying for online are being reimbursed mainly for med checks, email communication, or mental health therapy when a patient cannot be seen at their office.