This is an important announcement concerning upcoming possible insurance policy changes for those who are currently engaged in tele-therapy and who use medical insurance to pay for these services.
Even though there is encouraging news regarding the COVID-19 pandemic, with reports of dropping positivity rates, greater vaccine availability and expanded vaccination locations, the CDC and the President have made it clear that we are not yet out of the woods. Specifically, they have strongly warned against prematurely loosening COVID-19 precautions for things such as social distancing, wearing masks and avoiding being in indoor, non-ventilated settings for more than fifteen minutes.
Despite the persistence of the COVID-19 threat and the repeated warnings from federal agencies and officials, New York’s government has been asleep at the switch and has failed to extend the governor’s executive order which declared that New York was in a “state of emergency”. In doing so, the declaration provided for full insurance coverage for tele-therapy for counseling. This order also directed insurance companies to suspend copays, co-shares and deductibles regarding behavioral health services and also stipulated that reimbursement for tele-therapy be on par with face-to-face counseling.
On April 21, 2021, this executive order will expire. At this point, it is not clear what insurance companies will do or what changes will be made concerning eligibility or payment for tele-therapeutically delivered counseling provided after that deadline.
The concern is that insurance companies will simply return to pre-COVID-19 policies and, because of this change, many clients could be adversely affected . It is very possible that suspended co-pays, co-shares and deductibles will be reinstated and other supplemental fees may be added. In addition, clients currently working with out-of-network therapists via tele-therapy may be directed to seek counseling with in-network service providers.
Since there is still time before the order lapses, there is time to take action and sound the alert. Please call the number on the back of your insurance card and talk with your claims representative about what changes your particular carrier intends to make with regard to your benefits and coverage when the current emergency order expires.
If you find that there will be changes to your insurance coverage which adversely affect you, please contact your local state legislator and senator and explain why it is that you need their help . Encourage your representatives to extend the state of emergency until medical authorities give the all clear .
If you have any other questions, please call me at 315 380 1005.
Rev. Michael Heath, LMHC, Fellow AAPC 3 10 2021