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Barriers to Using Insurance for Telehealth Sessions

TBHI is delighted to be launching a series of Q&A from our audiences. In this blog, then interspersed with our other news and features, we’ll post a question obtained from one of our Trainees. One such question will be drawn and answered regularly. While we can’t answer each question individually, we will try our very best to respond to all your queries. Send us your questions/enquiry/concerns by dropping an email here.

What are some barriers to using insurance for telehealth sessions?

 

Barriers to Using Insurance for Telehealth SessionsYou need to be approved by an insurer to get paid by them. Start by calling the insurer to ask for their procedure codes. If they accept your service, they may ask you to get credentialed, typically referred to as “credentialing” or “paneling”.  Typically, counselors haven’t been getting reimbursement for Medicare, despite trying to change this for decades. Other groups such as social workers, psychologists, psychiatrists, nurse practitioners, psychiatric and other nurses as well as health coaches in some states can be credentialed and [paid by insurance companies. For more information about reimbursement, consider taking the convenient online course at TBHI described here: Reimbursement Strategies Increasing Authorization & Payment.

Counselors may also benefit from knowing that Medicaid, which is funded through DSHS at the state level, will approve certain Master’s level providers if they have the “right training and/or experience” — typically a specialty in working with families and especially children. They are expanding their criteria, so there seem to be growing possibilities for counselors who explore these areas and others. Your advocacy efforts will be needed to help bring counselors into that reimbursement stream.

Ultimately, we need national and international licensure agreements across states and countries. It will more quickly when enough of us advocate for such change. Look for telehealth legislation at both your state and the federal level, and get involved by sending a note to your state representatives to let them know how important telehealth can be to the people you serve.

The limiting same law and regulations apply to all groups, including college counseling, EAP, and all forms of residential care, be it in schools or any form of treatment facility. This comes as a surprise to many professionals employed in these settings, many of which have been violating these rules for decades. The only groups enjoying a relaxing of these laws include the military and Veterans Administration. These highly controlled groups are leading the charge to change many of the outdated rules currently in place.  If in doubt about your specific circumstance, don’t take anyone else’s word for it —  go directly to the board regulating your work and ask them for written clarification of their rules.

Most states are deciding that U.S. clinicians must be licensed in the location of the client/patient at the time of clinical contact. In some states, you may be allowed to simply “register” with the client/patient’s local state board. They might allow perhaps 30 days or 30 contacts in a calendar year instead of requiring full licensure. This registration process may require that you notify them in writing that you are delivering professional services to one of their citizens.

Such laws then would pre-empt professionals from working for online companies who deliver care 24/7 to any new clients with a credit card. Professionals working for such companies usually do not realize how much they don’t know.

However, when a licensed professional is working with the law and ethics for their profession, appropriately licensed, a proper informed consent is obtained, emergency systems are set up in advance, and the professional has been adequately trained to know how to handle the many differences between in-person and telehealth care. In fact, since 1999, we at TBHI have predicted that there soon will be day when neglecting to give a telehealth referral will be considered below the standard of care when a more appropriate clinician is available through telecommunication or some other form of technology.

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