Now more than ever many of us need to speak with our therapists. Levels of anxiety are running high, and mood swings seem the new normal for those of us with anxiety, depression and bipolar disorder.
But orders from most state governors have us stuck inside, even in quarantine, and our therapists’ offices are closed to in-person sessions. While therapists and doctors are scrambling to set-up the technology to conduct appointments over the phone, through FaceTime or Skype, many aren’t equipped to make the change quickly. And the demand is overwhelming.
To top it off, we have no idea whether or not insurance will cover therapy sessions conducted over media instead of in the office.
There are companies like BetterHelp and TalkSpace that already do this. But the last thing I want to do right now is start over with somebody new. Somebody who doesn’t know me at all. In times like these, consistency is important. My therapist and I have a rapport and a routine. I want to keep that.
Besides the unfamiliarity with conducting sessions on-line, there are a slew of regulations that make such visits difficult, or even illegal.
Typical health insurance companies outsource mental health coverage administration to large behavioral health management companies. Anyone who’s tried to deal with one of these companies knows they are as anxiety provoking as the fear of Covid-19.
The codes your therapist and/or doctor uses for in-person visits will lead to a rejected claim when you don’t see them in the office. And many policies don’t cover on-line visits at all. A neighbor has a practice with 40 therapists. One large administrator is being very cooperative and working hard to make sure everybody gets paid, regardless of where the visit takes place. The other large administrator isn’t budging at all.
Therapists can only do so much pro bono work, and most clients can’t afford to pay cash for their visits.
Telehealth doctors are available for emergencies with prescriptions, but they cost an average of $49 and often don’t bill through insurance. One large provider in my city says they are not equipped to change that, and they recommend that people who must bill to private insurance, Medicare, Medicaid, or pay in cash, visit one of their urgent care clinics.
The last place I want to be right now is in a clinic full of sick people.
Medicare and Medicaid have adjusted their policies to allow for payment to telehealth providers, but that doesn’t mean the provider can quickly set up the administrative functions to accept such coverage. Many are still turning away people who seek third-party payment.
Federal and state regulators have been scrambling to change policies that limit private insurance companies from covering telephone therapy sessions, but again for most practices this is all new and few are prepared, as much as they try, to make quick changes.
The therapists and their administrative staff are working from home and communication aimed at making major changes is difficult. Plus, therapists rightly want to do therapy, not get tied up in back office tasks.
Then there’s HIPPA. HIPPA regulations prohibit much information transmission through telephone and on-line visits because this communication is not secure. Privacy violations are risky and possible. However, Health and Human Services has issued an exemption from this regulation for many telehealth providers. You can see that memo here.
It’s not entirely clear how this memo impacts psychiatrists and psychotherapists.
Finally, state licensing of therapists can be an obstacle. Many cities are on the border between two or more states. If you see a therapist in the state you work in, but are now working from home in a different state, it is very possible your therapist is not licensed in the state in which you reside. If that’s the case, they can’t legally treat and bill you while you’re out of state. Even over the phone.
As in so many industries, the technology that makes new forms of healthcare possible is way out in front of the regulations. If there is any positive in the coronavirus pandemic, it’s that catching these regulations up with the technology available is happening at a quickening pace.
But at such a pace mistakes will surely be made and new holes will open up. Any good therapist will make arrangements to ensure that you are well, and well-treated during this time of crisis.
The record-keeping and payment system may be a nightmare, but realize that you are safe. We’ll all get through this, and while it’s sure to be anxiety provoking, it’s likely that a friendlier and more functional healthcare system will be in place when this crisis is over.