KXAN: Insurance companies not paying telehealth claims for mental health care in Texas

AUSTIN (KXAN) – Holding a cell phone to her ear, it only took a few minutes for Meghann Gordon to reach deep inside the walls of Blue Cross Blue Shield of Texas and find a human being.

Even during a global pandemic, BCBS had someone waiting to help.

But, even in that moment of relief, Gordon would—once again—find disappointment. BCBS of Texas was holding hostage a decision over whether she could see her therapist using videoconferencing.

But, it's a hostage situation without a ransom.

"Is that still in review, are they still making a decision on that," Gordon asked a rather polite BCBS representative. "Right, right, it's still in review," the worker told Gordon. "Do you know how long it's going to be in review?I've tried to follow up every week a couple of times a week," Gordon asked before she was abruptly interrupted by the BCBS worker who appeared to have been prepared for the question.

"No, ma'am," the worker said. The pair ended the call.

Gordon is like potentially hundreds of thousands of Texans who are finding out their employer-sponsored health insurance policies might not cover telemedicine visits for behavioral health care.

The old saying that it's better to be lucky than good describes exactly how we came across Meghann Gordon.

We were fielding multiple complaints from behavioral health providers, frustrated that a major insurance company was not covering mental health visits performed over teleconference.

We scoured the internet looking for a patient. Of course, finding someone to talk openly about seeking care from a therapist isn't the easiest thing to do. Gordon, who we never ran across in our research, took it upon herself to email us asking for help.

Gordon had followed all the rules and paid her insurance premiums. She'd been seeing her therapist for months and BCBS covered those visits. But, when stay-at-home orders were handed out in response to the coronavirus pandemic, her therapist had to stop seeing her in person.

No problem, they'll just meet over a telehealth line.

It uses similar technology as a FaceTime call, except the telehealth portals provide protections to make sure patient health information is secure over the connection. The technology is used by medical doctors regularly.

We haven't fielded a single complaint from a physician related to an insurer failing to pay for telehealth visits.

"When I called them, they told me that they would not cover that visit, even though she's a participating provider and they've covered in-person visits before," Gordon told KXAN in an interview last week.

She got word from BCBS nearly three weeks ago that her therapy sessions performed by telehealth portals would not be covered.

"Your insurance provider is telling you, because you can't see your provider in person, we're not paying for it," KXAN investigator Jody Barr asked Gordon. "Yes, exactly. They're only willing to pay for in-person visits," Gordon said.

That phone call to BCBS was the fourth time Gordon said she's called in nearly three weeks. Gordon said she's even had her benefits manager where she works call BCBS to find out why she was being denied coverage. It was the same answer, she said.

Her claim is still in review, despite BCBS telling her from the outset that she would not be covered.

"It doesn't make sense and it's really unfortunate because people really do need care in this situation. We're going to see more people requesting care and I think it's really selfish and irresponsible on the part of Blue Cross Blue Shield of Texas to refuse to cover these visits," Gordon told KXAN.

Meanwhile, she's been unable to see her provider for three weeks.

Providers are having the same problem

You've likely never met anyone taking social distancing more seriously than psychotherapist, Anita Robertson. When we showed up to interview her, she never got closer than six feet.

And when we accidentally got close, Robertson was quick to remind us of the six-foot buffer.

She's taken the same approach with her clients—some who suffer from severe depression. Others are suicidal — each one needs her services.

"You just go on here and just hit—click video call and it just sets you up and all of a sudden you see each other's faces and you just start talking," Robertson said, showing off her telehealth portal on her laptop and smart phone. Ever since the stay-at-home orders came down, Robertson's switched to telehealth to continue seeing her patients.

But, it has not been an easy transition as a lot of her time is spent on the phone with insurers trying to figure out whether her patient has coverage for her to see them over a telehealth portal.

"To also be taken up this time to say: do I have care, do I not? In a time where maybe I might not be losing my job—or have lost my job—do I have coverage for this because, if not, I might now have to be choosing my mental health over food for my family or food for myself," Robertson said.

The problems aren't with state-regulated health plans. The problem is with private, employer-sponsored plans, according to the interviewed providers. Telehealth coverage in those private plans is policy-by-policy, according to Robertson.

"All state plans are covered, but that's only 16% of insurance, but when you have a major provider like Blue Cross Blue Shield, it's plan specific," Robertson said. BCBS also requires a provider to use its MD Live telehealth portal before the insurance company will pay to cover the visit, Robertson said.

Although, BCBS disputes that and told KXAN the insurer will pay reimbursements to providers who might use another telehealth portal so long as the patient's particular plan allows it.

"If I wanted to get credentialed with them, it'll take over 90 days—I imagine more because everybody is needing telehealth—and so, 90 days can be—that can be life or death for a person depending on their illness and also depending on all the factors that are happening with this pandemic that can put people more at risk for suicide, for severe depression, for severe anxiety—I mean, it is really, really scary for what's going on and the impact it can have."

"We're hearing a lot of conflicting information about: will this be covered? Providers are hearing different information, my clients are hearing lot of different types of—for example, I had a client who called and they said yes, we'll cover it, then they called it back and said your plan does not cover that," Lacey Fisher, a licensed professional counselor in Austin told KXAN.

Fisher said some of the insurers she's dealt with would only reimburse for telemedicine visits performed through the insurer's own telehealth platform. Before the coronavirus pandemic, Fisher said therapists never had a need for the technology and now it's the only way to continue providing care.

"This is especially a time where it's super important that everyone has access to mental health. This is a collective fear and collective anxiety stress that everyone's going through," Fisher said.

Despite the problems with getting patients covered, Robertson admits she isn't turning away those who need help, "Also, ethically as a provider, I feel like it would be unethical to stop treatment just because people can't pay in this time because it would create way more harm and yet it's also unsustainable for me long-term to be able to see clients for copays or for nothing."

Robertson said she's "scared" when she thinks about "how bad this can get" for people needing mental health care during the pandemic. The isolation is a risk factor to suicide, according to Robertson.

"It's valid, it's an illness, it's a need. Why aren't we taking care of people when they probably need the most mental health support ever, as a whole, during this pandemic," Robertson said.

Possible Congressional Fix

On March 13, Texas Governor Greg Abbott took a step that many in the state's therapist field celebrated. With his signature, Abbott removed barriers to telemedicine that had long blocked the profession from using teleconferencing to provide services.

But, Abbott's order only applies to state-regulated health plans administered through the Texas Department of Insurance.

Those state plans only account for 16% of Texans, leaving 84% of the state under employer-funded plans, federal government plans — or some are uninsured.

"It leaves out the majority of Texans and it does not align with what the Governor's emergency order does for state-regulated plans or those federal plans, which are what the majority of Texans do have," Alison Mohr Bloeware with the National Association of Social Workers of Texas told KXAN.

Boleware said the top complaint her organization is hearing from therapists across the state is having to do with telehealth and insurers not covering those visits.

"They are getting the run around, they have to use a certain platform to do that and sometimes it can take months to get enrolled with a certain platform—or we're being told that plans are having to jump through other administrative hurdles that it is delaying someone from getting the needed therapy or treatment that they need," Boleware said.

It's something Boleware said Texas legislators cannot change. The change to mandate insurers cover telehealth services for behavioral health would come from Congress, she said.

We asked both U.S. Rep. Michael McCaul and U.S. Rep. Lloyd Doggett whether they've heard from Texans not being covered. Rep. Doggett's office responded, telling KXAN the office was aware of the problems with private insurers covering telehealth visits and had taken steps to "mandate payments" in the latest stimulus bill.

Rep. McCaul's office responded, telling KXAN the office has been in contact with BCBS and is investigating which federal law or regulations might need to change and why insurers are denying some telehealth claims.

"We sought in our most recent proposal to mandate payment for some services. But McConnell and Trump refused. While some private health insurance carriers are covering these services, others are refusing. This is one of the many issues that must be resolved in a future relief package," Rep. Doggett's Communications Director, Kate Stotesbery, wrote in a statement to KXAN.

"We did manage to secure grant funding in the bill approved on Friday to assist providers in expanding their telehealth capacity, including for behavioral health and substance use disorder," Stotesbery wrote.

The initial coronavirus stimulus act President Donald Trump signed gave some authority for Medicare to cover behavioral health visits performed through telehealth portals. Doggett's office said it heard from Texans after that bill that "some private insurers are not covering telehealth visits," Stotesbery wrote.

Although, Doggett's office did not confirm whether the congressman would draft legislation to mandate telehealth coverage in private insurance policies, Stotesbery told KXAN the congressman "strongly supports" any legislation to require the visits be covered by private insurers.

Blue Cross Blue Shield's Response

When we left Meghann Gordon last week, she didn't project much hope for getting her problems with BCBS corrected. As of this report, she's still awaiting word from the insurance giant on whether she'd be covered for telehealth visits with her therapist.

It's now three weeks without an answer.

We asked BCBS of Texas about the claim denials. The insurer, through a spokeswoman, issued the following statement:

"Blue Cross and Blue Shield of Texas is waiving co-payments, deductibles, and coinsurance for covered in-network medical and behavioral health services delivered via telemedicine. This applies to all members who have state-regulated plans and members with employer-funded health plans unless their employer chooses not to provide telehealth services for its employees," Laura Tolley wrote to KXAN.

Tolley suggested providers go to the insurer's website to find out about reimbursements and billings. Anita Robertson's tried that, as well. So has Meghann Gordon.

"Unfortunately, their web site is rather vague and honestly, it's not useful at all," Gordon said. "It really does not need to be this complicated and there's so much more harm that can be done for everything that the shelter in place is doing, for all the recommendations, that it doesn't make sense to me why there's so many barriers in place."

BCBS also suggested its customers can "…access telehealth through providers who offer the service through telephone and/or video consultations or through their Virtual Visits (MD Live) benefit," Tolley wrote in her statement.

Robertson and other providers we spoke with for this investigation all confirmed a 90-day wait to be credentialed by BCBS for this service under normal circumstances.

We asked Tolley clarifying questions concerning Gordon's case, in particular. Although she couldn't provide any specific answers citing privacy laws, Tolley told KXAN that BCBS "stands by our statement."

Tolley, who seemed confused as to why Gordon was being denied coverage—suggesting at one point in the call that it was Gordon's employer who was denying the telehealth therapy claims—asked that we send the company Gordon's contact information so BCBS could look into the problems.

Gordon agreed and we passed along the information on Monday. Gordon did not hear directly from BCBS, but told KXAN late Tuesday that the insurer informed her employer that "Now until at last 4/30/2020, member cost-sharing for covered, medically necessary medical and behavioral health services delivered via telemedicine or telehealth by a qualified in-network provider is a covered benefit. "

"We'll see if they follow through," Gordon told KXAN.