Insurance coverage for telehealht, con't

Richard Sethre, Psy D , L P. 6 years ago in Industry News/Discussion updated by Ashley M 6 years ago 6

I am following up on recent Procentive User Forum discussions about telehealth, in particular the question of whether insurance companies doing business in MN pay for telehealth when the recipient is in their home.  I am working my way through the local and national companies, and so far every company  has told me that they pay for telehealth when the recipient is in their home. 

The outlier is BCBS MN, which has a policy that clearly states that payment is limited to services provided when the recipient is located at "another facility.

I have had an interesting exchange with a BCBS MN representative.  He confirmed that they pay only for services provided when the recipient is in another facility, and not in the home. I pointed out, however, that DHS specifically covers telehealth when the recipient is in their home, and BCBS has a PMAP contract which requires them to cover DHS benefits. He acknowledged this and said that he would "have to research this further." I have not heard back, but it has only been a week and I expect that he will have to work with others at BCBS internally to sort this out. 

Stay tuned.

I have a quick question related to this.  Does anyone know if the telehealth modifiers apply to sessions performed over the phone?  One of our therapists was recently out sick, but did a session over the phone and I'm wondering if we can bill the insurance company for this.

  This is actually a pretty complicated question.  To properly provide telehealth, or telemental health, services, you need to: 1. confirm with your malpractice insurance company whether your policy covers telemental health services. 2. Confirm with the insurance company in question whether they cover telehealth services. 3. Confirm with the insurance company whether you need to provide documentation to the company about you preparedness/competence to provide telemental health services, including HIPAA compliant technology and having completed training for providing this service. I have posted a blog that covers some of #3. 

Or, you could call the company to see if they would be willing to reimburse a one-time session by phone.  That would be the squeaky-clean way to handle it. 

Frankly, I think that many - probably most- clinicians would probably just bill for the session and hope to not get audited - am not saying that this is the correct response.....

Hi Richard, 

I love it when our customers dive in and help each other out! This is a huge part of what makes our community great.

Check your email for a special "Thank You" from Procentive. Just our way of saying "Thank you for helping out"!

Telephone sessions are generally not a covered benefit.  I would call the individuals insurance and ask. 

Thank you Richard and Susan for your thoughts and advice!