Online therapy for mental health issues like depression and anxiety typically consists of counseling over video, phone or text. It’s not a new concept, but more insurance companies are expanding their policies to cover the cost of sessions, as this form of virtual care is on the rise.
Here’s what you need to know about online therapy insurance, including the way it works, differences between in-person coverage and how to determine if your insurance company provides the benefit.
Online therapy offers an array of benefits—therapists might be able to treat more patients virtually than they’re able to physically, and patients are able to receive health care from the comfort of their home or office. The quality of online therapy is just as effective as in-person sessions, too, research finds. Plus, it can be more convenient and a time-saver for patients seeking help for mental health concerns.
Indeed, online therapy is becoming a more widely accepted health benefit. And, since regular therapy sessions can be costly with many relying on health insurance to cover the bill, some insurers are offering options that cover a spectrum of telehealth services.
In fact, before COVID-19, Medicare and many private insurance providers often did not cover telehealth—and if they did, coverage was inconsistent, with some only reimbursing teletherapy done through video, but not over the phone, notes Yasmine Saad, Ph.D., a psychologist and founder and CEO of Madison Park Psychological Services in New York. Now, Medicare allows providers to use telehealth for therapy and other counseling services per the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, which expanded access to mental health care conducted online.
For Medicare specifically, patients largely pay the same price for online therapy as in person, according to the agency’s website. Some states have their own rules, however, which require professionals offering certain services such as behavioral health to be licensed in the same state in which the patient lives. So, it’s important to check your coverage beforehand with the therapy service or insurance provider.
Still, coverage for online care depends on your insurance company, not the therapy service. Each online therapy service has guidelines for what insurance plans it accepts, as well as what types of mental health areas are covered by their specialists. You may find a myriad of behavioral health concerns covered, including grief, depression, anxiety, addiction, teen counseling and medication management services with one particular online service. But you may need to pick another for more serious behavioral health conditions.
How Online Therapy Insurance Differs From In-Person Coverage:
Online therapy typically costs less than in-person sessions as therapists’ overheads (such as office rent) are reduced, according to Bethany Cook, an adjunct professor and board-certified music therapist in Chicago.
Many states have set rules for fully insured private plans to equally reimburse for online therapy as for in-person care. If you’re interested in getting help online, your first step should be to verify if your policy offers similar benefits as in-person therapy.
In terms of mental health, the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act requires medical professionals to include mental and behavioral health in their offerings. The parity law casts a wide net, generally offering coverage under employer-sponsored health plans for companies with 50 or more employees, coverage purchased through the Affordable Care Act, Children’s Health Insurance Program (CHIP) and most Medicaid programs.
Does My Insurance Provider Cover Online Therapy?
Online therapy can be tricky to navigate, especially with individual state regulations, treatment requirements and the type of provider affecting your level of coverage.
Although reimbursement from Medicaid and in-network coverage has been made possible by a soar in teletherapy visits due to the pandemic, there may be copays or deductibles in your plan. As for out-of-network benefits, you will typically pay in-full to the practitioner and be reimbursed by your insurance company based on your coverage.
How To Set Up Insurance For Online Therapy:
The first step to ensuring you’re covered is to confirm with your insurance provider if online therapy is included in your plan at all. Research which therapy services accept your insurance and double-check they are in-network, suggests Cook.
If teletherapy is offered as an extension of your existing in-person therapy, you might be able to get coverage, adds Dr. Saad. “The practitioner will have to code the teletherapy sessions with a modifier to indicate that although the treatment is for in-person therapy, teletherapy is sometimes also needed.”
You may also want to consider if pre-authorization is required for coverage prior to starting treatment, and if there is a set limit of visits that are covered under your benefits. The easiest way to find out is to call your insurance company to understand the full terms of your benefits before proceeding in your search.
How Much Does Online Therapy Cost?
When it comes to cost, the final price depends on a number of factors, including how much the therapy service charges. Some insurance companies may require a copay, while some might pay for the cost of care directly. Others may provide partial reimbursement after you pay upfront.
If your insurance covers online therapy, payments are typically included as a total coverage, meaning your insurance company pays the service directly. Or alternatively with out-of-network benefits, you first pay out-of-pocket.
Deductibles are also more common for out-of-network providers. For example, if a session costs $250, and your insurance considers $200 to be reasonable, they will reimburse $200. That amount is usually between 50% to 80%, says Dr. Saad. So, it’s important to understand your coverage alongside the reasonable rate for the therapist’s billing code.
Be sure to check if your online therapy service is subscription-based or paid by the session. Most of the answers can be found on each company’s FAQ page.
Some therapy apps offer cognitive behavioral therapy through bots rather than humans, and not all mental health issues can be treated online, period. If negative emotions become overwhelming, seek out a professional like a psychiatrist, psychologist or licensed counselor.