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Prescribed Isolation: Will Insurance Cover Tele-Therapy?

Like the rest of us, insurance companies should be socially responsible.

Gianfranco Grenar/Upsplash
Man looking at computer screen
Source: Gianfranco Grenar/Upsplash

What if you can’t meet with your therapist via telephone or video because your insurance company won’t cover it? You’re feeling a little sick but there’s no way you have COVID-19 because other people get bad things but you don’t. You know it’s your civic duty to stay home but you really need this session because the ominous cultural anxiety is getting to you and it feels like you can barely breathe. Wait: Trouble breathing is a symptom of the virus, so now you start to convince yourself you have it. Bad things always happen to you.

Darn it, if you could just see your therapist you know she’d provide that calming, safe space where you say your fears out loud and sort through your feelings until you can think more clearly. But both you and your therapist have called the insurance company three times each and gotten variable answers with no guarantee of coverage (breathe).

Not that you could afford it before, but now you really can’t because your hourly wages have disappeared or you’ve been asked to take a four-week unpaid leave instead of being laid off (deep breath). Or maybe you can, but you should probably save your money because your uninsured, asthmatic mother could get sick and anyway, you pay your sky-high premium on time every month so paying out-of-pocket for something that was supposed to be covered feels like being robbed (emphasis on the exhale). Vowing to cough into your elbow every single time even though you’re 99% positive you don’t have this plague, you decide to go see your therapist.

I’m usually not a fan of telehealth for psychotherapy. There is much to be gained in sitting face-to-face with another person without a screen and the various glitches that come with technology getting in the way. It’s easier to read body language and use other non-verbal cues that are so much a part of good therapy. Empathy and the experience of a holding environment just can’t be communicated as intensely through a phone or computer screen. For some, going to therapy is the thing that gets them dressed and out the door once or twice a week until they can find other motivation for being in the world.

But these aren’t usual times. These are unprecedented times for most people alive today, with whole continents scrambling to contain a virus that can be deadly and is threatening to overwhelm entire healthcare systems. Going out into the world is becoming less of an option for all of us and social distancing is being temporarily prescribed. Resorting to tele-therapy for awhile is necessary. But my colleagues on every mental health listserve I’m on are getting conflicting information. Some insurance companies have made provisions for telehealth for physicians and nurses but not for therapists. Should someone who could potentially be carrying the virus, or who’s on chemo or is pregnant, be forced to put themselves or someone else at risk so they can maintain sanity?

It should be clear cut: Insurance companies should cover any virtual therapy sessions as they would office visits. These sessions should be allowed to happen on any HIPAA-compliant platform and not limited to “authorized users of MDLive” or other costly, exclusive platforms. They should honor the Parity Act—the federal law that states mental health benefits may not be more restrictive than medical/surgical benefits—and make it easy for people to get the mental health treatment they need. Our mental and physical health are inextricably linked. That is why the parity act exists.

Just as we all need to take responsibility by not hoarding hand sanitizer and by giving up routines we rely on in order to help stem this pandemic, so too must insurance companies. While this situation is unprecedented, the need for ethical behavior is not. I sincerely hope insurance companies don’t turn a public health crisis into a money-making opportunity.

More from Jo-Ann Finkelstein Ph.D.
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