Depression and Anxiety Medication: Insurance Telehealth Claims
Requirements by legislation to increase access to mental health services have contributed to increased acceptance of depression/mental health telehealth claims by insurance companies, while non-compliance by providers is one of the reasons for the rejection of depression/mental health telehealth claims by insurance companies.
Acceptance of Mental Telehealth Claims by Insurance Companies
- According to a white paper by Fair Health, private insurance claims for telehealth services have increased more than 1,200% from 2012 to 2017, Fair Health's data shows.
- The paper also indicates that mental health topped the telehealth utilization list in 2016, but was fifth in 2017 at 7% of all telehealth claims.
- One of the motivations behind accepting telehealth claims for mental health is to encourage the use of telehealth as a cheaper and more convenient means to access care.
- Insurance programs like Medicare & Medicaid are accepting telehealth claims, although, this is restricted to claims from professionals that practice in accountable care organizations (ACOs).
- In June 2018, the Centers for Medicare & Medicaid Services (CMS) publicly encouraged states to utilize telemedicine and telepsychiatry to facilitate coordinated care for Medicaid recipients.
- Many health plans today cover and accept telemental health claims. This is partly because they are mandated by more than half of the U.S. states to ensure mental health parity; more so, the Affordable Care Act encourages this trend through its focus on accessible and affordable health care.
- BCBS of Alabama expanded its claims acceptance into telehealth for mental health claims citing that the technology used to treat mental health was “indistinguishable from a face-to-face visit.”
Rejection of Mental Telehealth Claims by Insurance Companies
- According to the report, "Telehealth Delivery of Mental Health Services: An Analysis of Private Insurance Claims Data in the United States',' telehealth claims for mental health are a small proportion of total claims, and average reimbursements for these claims are substantially lower than those for comparable non-telehealth services.
- According to a report to Congress, "an analysis of physician claims for Medicare services suggests that some portion of telehealth claims are supplemental rather than a substitute for in-person services."
- Some insurance companies reject depression/mental health telehealth claims from providers because of compliance issues. Providers who fail to comply with requirements as per individual state regulations often miss out out on reimbursement.
- Lack of clarity in the services for which claims are made by practitioners has also contributed to many cases of claims rejection by insurance companies.
- Under Medicare’s restrictive telehealth policy, it will reject claims from physicians and practitioners who issue prescriptions to patients without having a physical or mental health status examination to establish a provider-patient relationship.
Legislation Impacting the Acceptance of Mental Telehealth Claims by Insurance Companies
- The Mental Health Parity Compliance Act 2019 is currently in progress in Congress; it is an improvement on the Mental Health Parity Act that has to a larger extent encouraged the acceptance of telehealth claims among insurance companies. The legislation requires a plan's coverage for behavioral health treatment to be on par with its coverage for medical-surgical treatment.
- The Bipartisan Budget Act of 2018 signed into law in February 2018, encourages insurers to accept claims for tele-mental health services.
- The Mental Health Telemedicine Expansion Act (HR 1301) was re-introduced to Congress in February 2019; if passed, it would enable the acceptance of claims by Centers for Medicare & Medicaid Services from providers for home-based telemental health.