Therapists forge ahead with telehealth — not knowing if they'll be paid

The window that pops up on The Jonas Center website reads like this: “Due to concerns regarding COVID-19 and our commitment to your health and safety, The Jonas Center is only offering telehealth appointments until further notice.”

That’s not how client visits used to be, said Jim Jonas, director of the group which offers therapy at five locations around the Twin Cities metro area. Until a month or so ago, Jonas estimated that as much of 99 percent of their work was in person.

It was a scramble, but Jonas and the 15 therapists in his practice made the switch to telehealth. What remains to be seen is whether they’ll get paid for all of it.

Insurance companies covered telehealth before the pandemic, but the rules were complicated and strict. The provider had to be in an office and so did the patient. It had to be done over special platforms, not just a plain old telephone.

The government sets the basic rules for Medicaid and Medicare claims and the private insurers usually follow the government’s lead, with adjustments for particular plans.

Most of the insurers the center deals with have adopted recent changes for the reimbursement of telehealth services, said Jonas.

“Not all of them,” he noted, “but most got on board and said, ‘OK, we’re ... going to stay close to these guidelines and follow the federal guidelines, and for the time being during this emergency, we will cover platforms like FaceTime and just straight telephone calls.’”

The problem is things are changing so fast that nobody quite knows what’s covered and what’s not — all of which explains why Jenna Lindgren has been on the phone with insurance companies nonstop for the last few weeks, checking to see if telehealth is covered through clients’ different policies.

She works for a company, owned by Jim Jonas’ son Paul Jonas, that does billing for mental health providers.

“We call the provider services line,” Paul Jonas said, “and sometimes we’re told one thing and sometimes we’re told another. Clients are having this happen, too.”

The insurance company might say a plan covers telehealth, but what it may mean is that the patient can use a nurse’s line, not his or her own therapist.

For their part, the insurance companies are trying to figure out what they think works — or doesn’t — in telehealth, like phone and video visits.

“And then, you can determine whether or not that seems like, yes, that makes sense, that should work via the service that you’re using,” said Pamela Greenberg, president of the Association for Behavioral Health and Wellness, a trade organization that represents health plans.

The other challenge is to make sure the clinicians are actually delivering the service they promise and the care their clients need, she said.

The coronavirus crisis is forcing changes to telehealth that the insurance industry has long been reluctant to accept, partly due to concern that it might end up costing too much if more people could access care this way.

Now that circumstances have pushed insurers into allowing more telehealth, some of these changes may well stick, said Haiden Huskamp, who studies health insurance policy at Harvard University.

“This could really be a game changer for psychiatric practice going forward,” she said.

She and her colleagues have been talking to psychiatrists who say that so far, telehealth is going well. But until the insurance companies finalize their coverage plans, some providers — like Jim Jonas — are taking a gamble.

“I was willing to take the risk that I’m not going to get paid for all of this. And I’m still probably not going to get paid for all of this,” he said. “But I can sleep at night knowing that I checked in with my clients.”

Clinics are just starting to submit their March bills, which means they’ll know in the coming weeks which ones are paid and which ones are rejected.

If you are a provider or a patient who has had claims denied for telehealth since the COVID-19 crisis began, we’d like to hear from you. Email aroth@mpr.org.

This reporting is part of Call to Mind, our MPR initiative to foster new conversations about mental health.