You now know the benefits of online therapy, but you don’t know if private insurance covers online therapy? The good news is that online therapy, along with other mental and behavioral health services in the telemedicine space, is the most covered among telemedicine categories by insurance companies according to the American Telemedicine Association (ATA) 2015 publication on telemedicine gaps analysis. Other services include psychiatric diagnostic interview exams, mental health assessments, and medication management. The not-so-good news is that insurance coverage depends first and foremost on the state where you live and secondly on the private insurance company you have. However, on the upside, ATA indicates in its State Policy Toolkit of 2015, that more and more states’ policymakers are recognizing the benefits of telemedicine and increasing efforts to promote and adopt telemedicine policies. In the meantime, these are what you need to consider in order to know if your insurance company will pay for online therapy:
What are your state’s regulations and policies for private insurance parity?
Each sovereign state imposes different regulations and policies on private insurance parity, which defines whether in-person services are comparable to telemedicine?provided services. If a telemedicine service has full parity it has the same coverage and reimbursement as the equivalent in-person service.
As of May 2015, ATA reports that only twenty-four states have telemedicine parity laws for private insurance. This mandates insurance companies to have plans that cover telemedicine services. However, there are only 16 states, DC included, that allow statewide coverage, without any restrictions on the provider or the technology platform used.
What are your state’s restrictions on private insurance parity?
States have imposed restrictions on private insurance health plans to lessen parity for telemedicine-provided services. Examples of these are:
- Limitation on geographic area (e.g., rural areas may be authorized only)
- Only a predefined list of health care services allowed. This includes restricting the types of services and conditions that are covered via telemedicine.
- Restrictions on the provider, including the eligible provider type.
- Restriction on the technology platform, e.g., authorizing only the use of interactive audio-video systems.
- Imposing unreasonable, unnecessary restrictions on patient setting, such as only allowing telemedicine services to be performed in a physical health care setting (i.e., not from the patient home or workplace).
- Mandating an in-person visit to establish a provider-patient relationship.
What are your private insurance policies for telemedicine and online therapy?
Keep in mind that fraud, the lack of state enforcement, and general unawareness have hindered telemedicine and provider participation. It is up to you to know to ask your private insurance company what it covers and reimburses for telemedicine services and especially what the special “qualifier” code is that should be used by your provider when your insurance company is billed for these services. You do not want to be complicit in fraud. Other questions you need to ask your insurance company to know thoroughly about are: deductibles, copayments, coinsurances, limit to sessions, and network or preferred provider. Online off-line therapy service eTherapi.com offers users support in finding out whether their insurance will cover online therapy visits.
We need to all be our own advocate for online therapy and telemedicine services with our private insurance company and our state policymaker. Online therapy and telemedicine services like eTherapi reduce healthcare delivery costs, improving collaboration of care, and increasing provider access anywhere and anytime.
