A synchronous visit is a real-time video consultation. An asynchronous review is a provider assessing a submitted intake and deciding without a live encounter.
Sync costs more to deliver, requires scheduling and provider availability windows, and introduces no-show risk. It is also required in some states for initial prescriptions, and is the norm for controlled substances.
Most well-built programs are hybrid: async by default, with sync triggered by the patient's state, the therapy, or the clinical complexity of a specific case.
Requiring a video visit where one is not needed is the most expensive avoidable decision in a telehealth funnel. Skipping one where it is required is a compliance failure.
Async vs sync visits, in practice
It depends on the patient's state and the therapy. Several states require one before an initial prescription, and controlled substances such as testosterone commonly require a live visit regardless. The requirement should be enforced by intake routing rather than by policy.