Laura Groshong, LICSW, Director, Policy and Practice

What Will “Normal” Psychotherapy Become?

With videoconferencing and (thankfully!) audio psychotherapy, the possibility that we will no longer be forced to maintain the distancing that led to these forms of practice is beginning to emerge. What we can expect in the near to later future is at best likely to vary from state to state and region to region. Even the savviest crystal ball is looking cloudy!

Telemental Health Changes and Challenges

I have heard from clinical social workers from all over the country: the vast majority have moved in the past two months to doing psychotherapy through videoconferencing and telephonic means. I think it is safe to say that, while LICSWs used to feel frustrated by low reimbursement rates, lack of coverage for more than once a week treatment, and treatment reviews for psychotherapy that lasted more than a year, we now have a whole new set of frustrations.

A major challenge right now is the widespread discrepancy in terms of which private insurers and ERISA plans will cover videoconferencing and audio psychotherapy, which insurers and ERISA plans will cover or waive co-pays, and which insurers and ERISA plans will pay for videoconferencing/audio therapy at the same rate as in-person therapy. Of course the anxiety we face about becoming infected or infecting others colors everything we do, effectively rendering our insurance concerns less meaningful. And somehow, despite change and challenge, chaos and frustration, we persevere and try to maintain our professional and personal lives.

What will our practices look like in another 8 weeks, in 6 months, in a year, or maybe three years from now? We have no idea. Different states are following very different trajectories based on the way COVID-19 is impacting the people who live there. Indeed, some states are coping both with “Hot Spots” and, at the same time, with areas which are not only unscathed but demanding a return to “normal”.

So far, our state and local governments have been trying to create guidelines that will protect as many people as possible, mainly through physical distancing, hand washing, wiping down all high touch surfaces, and masks. That is the legal “frame”; we all still have to determine what we think is safe in doing our work in the present and moving forward.

Future of Telemental Health

Moving forward, is there a future for telemental health? Most important, according to my admittedly cloudy crystal ball, will be whether Medicare decides to maintain the expanded videoconferencing and audio psychotherapy, once the current restrictions in physical distancing are removed. Medicare policy generally impacts all the private insurers. Current physical distancing restrictions will be cut back on a state by state basis, so it is hard to say when CMS will decide there is “enough safety” to insist that all Medicare beneficiaries be treated in-person. Or indeed, will Medicare make such a decision? Will they have collected data and assessed the impact of videoconferencing and audio psychotherapy to determine whether these formats are as helpful as in-person face to face treatment? Are these formats effective tools for short term relief of mental health problems? For long term changes sought? How do they compare for in-depth trauma related treatment? It seems likely, too, that there will be questions of how much more or less expensive it would be to allow these forms of treatment to continue, where appropriate and effective.

CSWA will continue to work with CMS, HHS, and other national organizations to preserve the options that we now have, insofar as they are appropriate and effective, even after the crisis has abated. As you know, the predictions of when that will occur range from 3 months to 3 years.

Dealing with Insurance Issues in the Here and Now

Meanwhile, what do we do when insurers state they will cover the co-pays, pay the same amount for distance therapy as in-person therapy, describe which POS code and modifier to use, and then fail to reimburse according to these stated policies? These problems are some of the most frustrating we face. Spending hours tracking down provider liaisons about why our claim was denied, or paid at a lower rate, is painful and even scary. One remedy is to engage our patients in the process of finding out what their current co-pay coverage is. Keep a list of POS and modifier guidance as it comes out, by insurer, and keep it updated. If you find inconsistencies, let your insurance commissioner and attorney general know. This is the best way to get action on insurers’ failure to pay us what they have agreed to when we have complied with stated policies.

In other words, use your own judgment about what practice system feels safe for you and your patients and let insurers know that they need to be consistent. And most of all - stay tuned.