Traditionally, mental health services have been held in person but over the years, and especially since the COVID-19 pandemic started, technology has started to play a greater role. Telehealth is health care services provided through technology whether that is a voice call, video call, text message, or potentially even email. As these services have become more and more popular insurance providers have been attempting to determine when they would cover these services.
The Problem
When considering your therapy options, it is important to know whether the treatment you are going to be receiving is covered by your insurance. Throughout 2020 insurance plans utilized co-pay waivers and other temporary solutions to assist clients in getting the care they needed without having to worry as much about finances. However, in 2021 we are seeing that, while telehealth continues to be a preferred method of providing services for counseling and other helping industries due to the COVID-19 pandemic, that these temporary policies are no longer in effect for specific clients.
You may be wondering, "What does this mean for me?" Depending on the insurance coverage you have, you may be expected to pay a deductible instead of only having to pay a copay for services provided through telehealth. The Virginia Department of Medical Assistance Services has permitted Medicaid insurance providers to allow for telehealth to be covered fully (along with telephone calls) in order to help meet clients where they are in terms of technology availability.
"In response to the COVID-19 pandemic and the President’s emergency declaration and the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, the Centers for Medicare & Medicaid Services broadened access to telehealth services to include psychotherapy and other mental health practices.
According to the Medicare website, Medicare Part B covers certain telehealth services such as psychotherapy. For most of the services, you'll pay the same amount that you would if you got the services in person. That said, there are always caveats, and it’s in your best interest to contact the customer service number on your insurance card or ask your provider for more information" (Lindberg, 2020).
Commercial or employer-sponsored insurances, however, have been falling back to the plan benefits. While telehealth services have been around for multiple years at this point, it is not guaranteed that they are included in basic outpatient therapy service options in commercial and employer-sponsored insurance plans.
The Solution
In order to understand if telehealth services are covered fully, or if you will owe a copay or deductible, it is important to first understand what type of insurance you have. For a refresher on what copays, deductibles, and the different types of insurances are, you can check out our previous post, "How Do I Figure Out What My Insurance Covers?"
Once you have been able to identify what type of insurance carrier you have and have brushed up on what it means to have a copay or deductible, you will need to reach out to your insurance provider to review your insurance plan benefits. When you reach out to your insurance plan, be sure to ask them about "mental health telehealth benefits" in order to make sure you get a clear understanding of what they allow as part of your plan. After getting the benefits information from your insurance plan customer representative, make sure you get a call reference number (if they can provide you with one) so that you can coordinate with your mental health provider's billing department to make sure your claims are being processed correctly by your insurance provider.
"Also, check to see what documentation you may need to get reimbursed, especially since someone from your insurer can say your therapy is covered, but your claim may still be denied once your insurer reviews all the facts. “You may need to appeal, so keep good records of every conversation you have with your insurer,” says Hill" (Lindberg, 2020).
The Future and Other Options
Right now, insurance coverage for telehealth services can be confusing but since the beginning of the COVID-19 pandemic insurance companies have been actively working to adjust their plans to be more inclusive of telehealth services, especially for mental health. It will be important to stay in communication with your insurance provider regarding changes to how they cover telehealth services moving forward.
In addition, when considering options for telehealth services it is important to remember that there are community service centers such as community service boards or federally qualified health centers that provide free or low cost services, subscriptions services such as Talkspace, and low cost sliding scale services offered by therapists who are a part of the Open Path Psychotherapy Collective.
Calming Wind Counseling Services has been actively working to create the most affordable options for receiving care. We have established policies focused around making sure that we are assisting clients in verifying that they have telehealth benefits through their insurance provider, making sure that clients have appropriate documentation to appeal claim decisions, offering free counseling services by supervised clinical interns, and working with clients to create payment plans or other financial arrangements to keep services affordable.
If you have any questions regarding billing you can send us an email at billing@calmingwindcounseling.com. If you or a loved one are in need of counseling you can gives us a call at 804-416-5052 or email info@calmingwindcounseling.com.
References:
Lindberg, S. (2020, May 08). Does health insurance cover ONLINE THERAPY? Retrieved February 10, 2021, from https://www.verywellmind.com/does-my-health-insurance-cover-online-therapy-4842511