Austin Therapists Offer Telehealth During COVID-19 Pandemic. But Who Pays Isn't Always Clear.

Apr 1, 2020

Mental health care providers in Austin say they're finding it hard to provide telemedicine services to a big chunk of their patients – particularly those with large employer health plans from Blue Cross Blue Shield of Texas.

They say Blue Cross representatives have been giving providers and patients inconsistent – and sometimes inaccurate – information about what is covered when it comes to providing care over the phone or via the internet rather than in person.

“It’s all just up in the air right now,” Julie Walder, a licensed professional counselor in Austin, said. “We, as providers, have a lot of questions.”

"There is a great deal of frustration in the therapist community because we have a duty to serve our clients. It's a scary time to be a single-practice therapist."

Walder and others say a lack of clarity from Blue Cross – as well as sprawling bureaucracy and differing benefits covered by employers – has created a complicated situation for therapists. Many mental health professionals in Austin run private practices, which are small businesses, so unresolved questions about coverage could result in serious long-term financial issues.

Vanessa Gallagher, a mental health counselor here, said when she decided to switch to telehealth it was hard to figure out which of her patients would actually be covered.

“There is a great deal of frustration in the therapist community because we have a duty to serve our clients," she said. "It’s a scary time to be a single-practice therapist.”

Rachel Glaser, a psychotherapist with a private practice in Austin, said about 40% of her patients have a Blue Cross PPO plan. She said she wants to continue serving patients, who rely on her, from home.

“It’s also a big-picture thing,” Glaser said. “I want my practice to continue to stay open. I don’t want to cancel people as long as they want to come in, because when this is all over, I want to have a practice to come back to.”

 

Therapists are handling situations day by day, but continuing to provide care could come at a cost.

Glaser said she has reached out many times to insurance representatives at Blue Cross to ask whether she will be reimbursed for any of the care she is providing while people are being told to stay at home. She said she hasn’t gotten a clear answer – except a denied claim for a telehealth service she provided.

“I was told it would be pended and considered," she told KUT in an email, "but apparently they are continuing to deny it."

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A spokesperson for Blue Cross Blue Shield of Texas said in a statement that the company is getting rid of out-of-pocket costs for in-network telemedicine, which is available unless an employer "chooses not to provide telehealth services for its employees.”

“There needs to be an easier process for members and providers to figure out if the employer is not allowing telehealth,” Walder said.

Arielle Larson, a licensed social worker who co-owns Yellow Chair Counseling in Austin, said this isn’t easy for her patients to figure out, either.

In fact, she said, the question of who will pay for services has stopped some of her patients from switching to telehealth.

“The main barrier has been that they have not been able to get a for-sure answer … about whether it will be reimbursed the same as in-office sessions,” Larson said.

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Blue Cross Blue Shield of Texas is one of the largest insurance providers in Austin, particularly among people with employer-sponsored plans. For example, the company insures most of UT Austin’s employees, including KUT staff.

Earlier this month, state officials said anyone with a state-regulated plan – which largely excludes employer-sponsored plans – would be covered the same for telemedicine care using whatever platform they want.

Stephanie Goodman, a spokesperson for the Texas Department of Insurance, said it would be harder to get widespread coverage for federally regulated plans – which make up 40% of Texas’ insurance market. For those plans, the federal government would likely have to step in to mandate telehealth coverage, which would then be paid for by employers.

“It’s that individual employer who is paying the cost of the service,” Goodman said. “So it’s more complicated on that side.”

Providers say another wrinkle has been that Blue Cross has been pushing them to use its “Virtual Visits” portal known as MD Live. Almost all providers who spoke to KUT said they didn’t even consider getting credentialed through that program because it can take months.

“I knew from speaking to other therapists ...  I was looking at a three-month wait,” Gallagher said.

Ultimately, mental health providers say, this is a terrible time for people to go without care they need. They say anxiety, depression and disordered eating – among other things – are becoming serious issues as more people self-isolate for extended periods of time.

“It’s important to be able to check in with your therapist and someone who has been a support for you and just be able to process everything that is going on in your life right now,” Larson said. “I really hope that the federal government steps up and that employers step up and make this accessible for everybody.”

Got a tip? Email Ashley Lopez at alopez@kut.org. Follow her on Twitter @AshLopezRadio.

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