Does Your Health Insurance Pay for Online Therapy?

To prevent the spread of COVID-19, the respiratory illness caused by a new-to-humans coronavirus, many health-related appointments have moved online. Most of the conversation about this shift to telemedicine has focused on physical health. But if you’re in therapy, you know that mental health appointments have shifted online too.

In order to make it easier for providers to offer telehealth services, the government and health insurers are working to change telehealth regulations. For example, the Department of Health and Human Services (HHS) eased technology rules under the Health Insurance Portability and Accountability Act (HIPAA). Designed to keep patient data confidential, many phone or video conferencing platforms don’t otherwise meet the strict HIPAA standards, which makes it difficult for some providers to use these services.

President Donald Trump also expanded telehealth insurance coverage to all doctor visits under Medicare and Medicaid. Previously, telemedicine visits were only covered for those who lived in rural areas where an in-person visit wasn’t possible. But if you’re among the 68% of the population who has private health insurance, such as through your job, coverage for telehealth varies. Not to mention, it’s not always clear whether or not telehealth changes apply to mental health care. 

Insurance Confusion for Mental Health

Many people rely on their therapist for weekly appointments, especially now due to the stress of the COVID-19 pandemic. Therapists have had to “turn on a dime” and switch their practice over to telehealth almost overnight, multiple practitioners told The Mighty. For therapists who accept insurance, part of the process includes trying to understand if they will get paid for seeing clients remotely.

“The issue was figuring it out that it was covered and what to put in the claim to make it appropriate in their books,” Tennessee-based therapist Katie Casey, LPC-MHSP, told The Mighty. “It took multiple phone calls and emails from my billing associate and myself to figure it out. This had to be done in two days as I had to switch to telehealth very quickly as things began to shut down.”

Sarah Stroup, LMFT, RPT-S, a therapist based in Utah, described the insurance situation for online therapy during COVID-19 as “the Wild West.” Guidance from a combination of individual companies and local, state and federal governments has led to confusion, especially for mental health providers.

One insurance company Stroup works with refused to cover online therapy until the governor issued a stay-at-home order. Other companies tell patients copays will be waived, but will insurance companies cover that payment for providers? The answers are not clear and hard to find easily.

“This is where the chaos is at the moment,” Stroup told The Mighty. “Some insurance companies have taken measures to help their members but few changes have been made in writing, which is leaving therapists uncomfortable both ethically and financially.”

Does Your Insurance Pay for Telehealth Therapy?

Whether or not your insurance will pay for online therapy sessions, and how much, depends on your insurance company. Benjamin Sommers, M.D., Ph.D., professor of health policy and economics at Harvard T.H. Chan School of Public Health and a primary care physician, said during a conference call that Medicare and Medicaid will cover telehealth services. Otherwise, the decisions are made plan by plan.

To find out if your insurance company will pay for online therapy sessions, check with your therapist first. If they’ve been billing your insurance company for appointments, they likely have already been sorting this out with the insurance company. They can let you know what to expect or help you figure out what to do next.

You can also call your insurance company directly and ask about their coverage during COVID-19 for online therapy, including how much you will be expected to pay. America’s Health Insurance Plans (AHIP) has compiled a list of what most insurers in the United States have said about coverage during COVID-19, which may give you some additional insight on what to expect.

“This is a big problem. The solutions are not as straightforward,” Dr. Sommers said. “Making sure that people can afford care again and paying providers to offer those telemedicine services is important.”

For other resources on how to cope with your mental health during the COVID-19 pandemic, check out this article.