Remote Therapists - Insurance/FSA/HSA?

I know that some of you see "remote" therapists (by phone, skype, email, etc.).

Can I ask a little about how that works, logistically? Are they covered by out-of-network insurance, since it's therapy, even though you're not in the same state? Can you use FSA/HSA funds to pay for them?

Thanks...

Unfortunately, in none of my research have I found online/remote providers that are covered by insurance. For example, many of the companies that provide online therapy, like LivePerson, don't permit any personal information exchange, so providers couldn't even do the necessary paperwork for reimbursement, so that eliminates the larger organized services that I know.

While clients can sometimes see out of network providers and do the paperwork to submit to their insurance, the insurance plans I've researched do not permit billing for long-distance (non-face-to-face services) except, I've noted in rare cases, clauses that state distance consultations with specialists are covered where it can be proved that the service provided is unavailable within a reasonable driving distance.

FSA/HSA funds can not be used for distance therapy/mental health services to my knowledge.

Of course, I couldn't possibly have researched every insurance plan, so I'm generalizing based on my research, but I don't know anyone or any method to date that has been able to use insurance or be reimbursed for long-distance therapy.

Hope someone else has had a better experience.

My therapist and I meet via Skype..i pay with cash.

You could call your insurance about reimbursement, but i'd personally check into known policies and guidelines first. There are some resources below that might help. In my experience, insurance reps. often provide inaccurate information and sometimes try to screw you over.

eta: after seeing Leah's response, my therapist is in private practice, so even though he doesn't have organizational policies to follow, they have to stay aligned with practice ethics and of course laws.

I see Skies response has many links but mostly focused on Medicare: I don't qualify, I also pay out of pocket, but perhaps there is better coverage if one is eligible, though it seems from some of the writings patients are required to be inpatient to qualify to use telehealth services in at least some cases.

Thanks Leah and Skies... that sounds like what I was afraid of. Even without insurance, I was *hoping* that an HSA could be used to reimburse, but it looks like not.

Thanks for the links Skies... I'll take a peek.

Gosh, nothing's ever easy, is it? Thanks!

[Edit: Didn't realize that the links were re: medicare.... I don't qualify either. But thanks... good info to look at.]

Hmm. this is interesting.

This short document from one of the links I posted indicates that 12 states have laws that require insurance to reimburse for telehealth services.

...Also that 130 private payors reimburse; Blue Cross Blue Shield leads that trend.

ISSUU - TILT Magazine Issue 5 by Online Therapy Institute, Inc.

It usually takes a long time for organizations to catch up with technology, but it looks like it's getting there.

ps not the most credible source, but a starting point from which to explore. Yes it looks complicated!

But the definition of qualifying telehealth services is so limited.

When I researched it, it was limited to specialists who couldn't be found in person, and therapists are so common in most places.... sigh.

But if anyone's research uncovers better news, I'd love to hear it.

I know California had some improvements in the works, but... I don't know much more, if California has broader definitions or if any of the other states does...but in the article it looks like the 12 or 13 states that reimburse are for medicare distance consultations, and only provided from medical facilities, also, the editor's note on the back says most government and 3rd party insurance companies don't cover any of it.

That's because Medicare drives the policies for other healthcare organizations.

The organizations you see providers through Leah are different in terms of payment issues of hospitals and other healthcare organizations.

The CPT codes determine provider reimbursement. So generally if the insurance company pays the procedure codes below, then the services would be reimbursed pending meeting other guidelines if provided by qualified providers in private practice, hospitals, outpatient organizations, etc., who take that insurance.

P.S. Don't know if it's an option, but there are some providers that are relatively more affordable than others.

This service offers 8 weeks CBT type therapy for $200 (if you wait for the email offer after signing up) and then you can make arrangements for service with the same therapist after. Online Therapy | Evidence-Based Cognitive Behavioral Therapy (CBT)

Talkspace offers unlimited email sessions for $100 a month and you can add on sessions at $29 for 30 minutes. Online Counseling | Online Therapy | Talkspace.com

Thanks Leah... I appreciate it!

There are dozens of BCBS's, but I believe that the services you go through aren't eligible for reimbursement because of the nature of the organizations that you use. I checked several BCBSs, and there are similarities:

I do think that more people can get reimbursed for these services than one might think from reading this thread.

Covered providers include Social Workers, Psychologists, and Psychiatrists...Qualifying telehealth services are the codes I listed above, so they do not appear to be limited.

Looking this up for myself too since my insurance is changing. I'm really happy about finding this, because maybe that means I can see him more than once a week!!!!!!!!

Right, but you see, the service has to be rendered in the provider's office, hospital, clinic, etc. which eliminates the majority. And there are additional restrictions, and additional variables with different insurers, etc. So, the services are primarily not covered, but also, providers working from home are not covered, and many private practicioners refuse to handle insurance: they work on a cash/credit basis only. In addition, there are other restrictions in some cases, like the provider residing in the same state as the client for the provider to be able to bill insurance. Just a lot of random variables.

I mean, I encourage anyone interested to investigate thoroughly, but not to get their hopes up.

Yeah, realized we are looking at 2 different things. The sites you posted aren't healthcare providers (one is a software co.) and the stuff I am talking about pertains to medical/ healthcare orgs. Not sure what all the op is looking into, but I may have inadvertently increased the scope of the thread... Sorry Guilloche, if that's more than you wanted to know.

Still glad I can keep my hopes up since my T works in an office. The state issue is something I have to check into yet though.

Well, I'm talking about licensed therapists or CBT providers with those sites specifically, but not medical doctors. I'm not familiar, for example, with the psychiatrist side of things.

Basically, in my research, I have not found distance therapy to be covered by insurance or healthcare spending accounts.

I hope there are exceptions I just haven't discovered yet.

I provided the two sites I did because they provide services with much lower than average fees.

Many online providers charge $80+ per hour (I've seen rates from $50 - $300, with the $120-$150 range most common) but because the ones I've examined don't take insurance, I wanted to mention some affordable alternatives.

(Another concern with out of state providers is while they're licensed to do therapy, it's really only with clients in their state: licenses do not extend nationwide. My understanding is a provider typically needs a license for each state in which they'd like to practice. Here's an article I just found that speaks to this a little bit: http://www.personcenteredtech.com/20...s-state-lines/)

Yes, and i am referring to licensed providers working for healthcare organizations, including private practice, not those working for or as contractors for various internet commerce businesses.

The stuff I posted pertains to conventional provider practices rather than the internet based ones.

I was also referring to private practitioners, but not providers working for healthcare organizations. But anyhow, as I understand it, they can't really practice with clients out of state (not officially, not for reimbursement) as licenses are state-specific. (Though some providers do occasionally choose to get licensed in multiple states.) I just added a link above that speaks to that a little bit: Can I Practice "Skype Therapy" Across State Lines? - Person-Centered Tech

Do you think there might be some common exceptions? As far as I could tell, the exceptions covered were for when a suitable specialist couldn't be located locally- did you have any better luck?

I'd love to find loopholes, ha.

Leah, I'll look at this some more later. The licensure stuff varies greatly by state and seemscto be constantly changing. There appears to be loopholes in some states (eg needs license where provider practices vs. where patient gets treated.) Where's stopdog!

Check out GreatnessAhead. It's an online porn addiction therapy program for those who don't want a face-to-face therapy. I was informed that their program is affordable but you might wanna try giving them a call with regards to the aspects that relate to insurance, and stuff like that.