Using Your Insurance for Virtual Therapy Sessions For Your Child or Teen

Prior to COVID, virtual sessions were not the norm, and as such, many insurance carriers did not reimburse for online counseling or other services.  If they did reimburse for virtual services, they might authorized only select providers, such as Telehealth networks, to provide virtual services.  

However, COVID created a situation in which many providers were forced to close their office temporarily for their own safety and the safety of their patients, and some decided to shift to a completely virtual service or hybrid practice. Most insurances began approving temporary approval for virtual services.  And now, many have permanently approved certain virtual services, as it has become more accepted that Telehealth is a convenient and cost-effective way for patients get support. 

Here’s some things to keep in mind about using insurance:

1. Confirm with your insurance company that Telehealth or Teletherapy services are covered and at the same reimbursement rate as in-person sessions for you or your child prior to starting services.
   For benefit related issues, you can call the number on the back of your insurance card and ask your member representative about benefits and your providers network participation prior to initiating services.Due to the rising costs of health care, insurance benefits have increasingly become more complex and not all services, providers, or locations are covered. Understanding mental health or behavioral health benefits can be challenging for both providers and patients to determine exactly how much coverage is available. Some plans (commercial, state, and federal) have “Managed Health Care” plans or “carve outs” for mental health that may require pre-authorization before they provide reimbursement for services.  These plans, as well as EAP plans, are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a specified number of sessions.  
2. Make sure you update your provider or Telehealth network quickly whenever your insurance plan changes or a new plan year starts to avoid any surprises regarding billing.
3. Many providers and Telehealth networks accept insurance, but also many do not.  The providers or networks that do accept insurance may not be in network with your plan or be able to provide services in your state.  Have your current insurance card available when you interview a new provider so they can verify your benefits. They should be able to tell you if they accept your specific plan, and what your cost will be. 
4. Payment for all services rendered are generally considered by a provider to be the financial responsibility of the client or the client’s parent or guardian who signs the provider’s paperwork, even if insurance or a third-party (such as an ex-spouse) is paying. Most providers will tell you (and/or add to their written agreement with you) that while they try to be as accurate as possible when verifying benefits, your fees may change depending on your eligibility and benefits during the date of your sessions and they consider it your responsibility, as the patient or child’s guardian, to thoroughly check your benefits. Sometimes the information a provider receives from an insurance company when benefits are verified may be different than the EOB once insurance claims are submitted. If an estimate or verification is given, this is an estimate/verification as of the date it was received, and you and the provider may not know your exact fees until the provider has billed your insurance and you get your EOB back from your insurance company. For example, let’s say you sign paperwork with your new therapist, but you don’t start therapy for two weeks. But during those two weeks, you see a psychiatrist and/or have psychological testing.  This could affect your deductible, and what you will be asked to pay by the provider when you have your therapy session.
5. Providers and Telehealth networks may accept one or more of the following for payment of their services:
   • Self-pay (cash)
   • Commercial insurance
   • Employer-sponsored plans
   • EAP
   • Medicaid (state plans)
   • Medicare
   • Third-party payors (post-adopt services, WRAP around services, grants, etc.)
   • Health or Flex Savings Account type plan
6. Some clients choose not to use their insurance, particularly for mental health benefits, as they prefer to control choice and confidentiality. If you choose to use your insurance, please be aware that:  
   • A diagnosis of one party (if appropriate), who is present for the session, and documentation of medical necessity MUST exist for insurance reimbursement. This means, if a provider accepts your insurance, they are required to diagnose the person being seen to bill your insurance and they will be required to determine a clinical diagnosis that becomes part of the official patient record. 
   • Sometimes a provider may be asked by the insurance company to share additional clinical information, such as treatment plans, progress notes or summaries, or copies of the entire record (in rare cases), particularly if there is an audit by the insurance company.  This information will become part of the insurance company files.   Though all insurance companies claim to keep such information confidential, your provider has no control over what they do with it once it is in their hands.  In some cases, they may share the information with a national medical information databank that may stay on your child's record for life. 
7. If you have Medicaid, there may be stipulations that you must use in-network providers. Plan participation is generally related to need-based assessment, so it may stipulate that you cannot pay out of pocket for the same services that you could receive under your plan. Paying privately for services covered by your insurance so you can see a particular provider could jeopardize your benefits. If you are having difficulty find a network provider you feel is qualified to meet your child's needs, discuss with your insurance company so they can assist you in determining the best course of action.
8. Payment is usually due at the time of service.  If you are using insurance, then you will likely need to be prepared to pay your co-pay or meet your deductible at each session.  Most providers or networks will be accept payment via all major credit cards, debit cards, and in some cases, HSA or FSA card, through their secure electronic processing.
9. Even if you are using insurance, most providers or Telehealth networks will require that you complete a credit card authorization form, to hold your appointments and will use this card for any adjusted fees due to insurance claims, late cancellations, no-shows, non-insurance covered services, etc. according to the terms of the agreement you signed.
10. If you have third-party reimbursement, such as through post-adoption services, you will need to make sure the services are covered by the type of provider and/or network you are seeking services from.  Some programs have specific requirements for reimbursement regarding the provider’s licensure, number of sessions, and location of services. They may also require a written understanding regarding sessions. Also, although information disclosed in sessions by a licensed provider is held in strict confidence according to HIPAA regulations, if you are using a third-party payor, the provider will likely be required to maintain and provide documentation of services, including a diagnosis, treatment plan, goals, and progress to process claims for reimbursement.   
11. Insurance and third-party payors will not pay for missed appointments or “no shows”, copies of records, documentation (letters to schools or employers), school meetings, court testimony and depositions, etc.  Therefore, in these circumstances you will be financially responsible as outlined in your financial agreement with the provider. 
12. If you do not have insurance, and you’re paying out of pocket, you may want to ask the provider if they have a cash-pay rate or a sliding scale fee.
13. If you have a commercial insurance plan, but your provider is not in network with your insurance, you may be eligible to receive reimbursement for all or part of a provider’s fees through your insurance company.  If you receive Out-of-Network (OON) benefits from your insurance coverage, ask your provider if they can provide you with a receipt (Superbill), upon request at regular intervals so that you can seek reimbursement from your insurance carrier. However, it’s important to keep in mind the following:

• The Superbill will generally need to have a diagnosis on it.
• Also, when using out of network benefits, it is up to you to negotiate and pursue reimbursement. The provider will generally not accept responsibility for making sure you get reimbursement.
• Not all services or providers are covered by your insurance, such as parent coaching and consultations, hypnosis, etc.

Be sure and ask your provider or Telehealth network about any issues prior to beginning services if you have any questions.