The Bewildering World of Telepractice Reimbursement

It’s a new frontier: computer screens are lighting up all over the world between SLPs and their clients to improve speech and language. Problems that people have with making or keeping regular appointments are being resolved with telepractice as they realize they don’t even have to leave their homes to receive quality speech therapy from an experienced clinician. It’s more than helpful for families with busy schedules, people in rural areas, and those with mobility issues. I think you’re getting the point: telepractice is a wonderful thing! However, as with many new frontiers, there are obstacles. Insurance reimbursement is one of them. As of today, only some insurance companies and state programs cover telepractice, which means that this service currently survives by many clients paying out-of-pocket. This post is about where insurance companies and state programs stand on reimbursement of telepractice and how to navigate the system.

My first advice is “just call.” ASHA has a wealth of knowledge about telepractice and some information about related reimbursement, but most articles suggest checking with your state or insurance company in the end because the information is ever-changing. Searching on a state or insurance company’s website for whether or not telepractice is covered is a sea of confusion. Your search will be lumped into similar searches for telemedicine and tele-psychotherapy which are also worthy new frontiers, but not the same as online speech therapy. So, to get the fastest answer, just call your insurance company. When you do call, don’t be surprised if they have no idea what you are talking about. In the eyes of insurance companies, telepractice is still obscure. Many of my fact-finding phone calls were mostly met with a similar answer: “I’ve never heard of online speech therapy before but it sounds like a good idea! Let me check with insert some other department here to see if they know whether or not it’s covered.”

INSURANCE COMPANIES

My journey began with calling BlueCross. I was optimistic about this call because I had read an ASHAsphere blog from 3 years ago where BlueCross came through. The blog told the story of a clinic in Virginia that decided to begin telepractice for busy families. To cover the cost through insurance, they searched and searched. Medicaid wouldn’t cover this service in their state at the time. They were finally able to get covered by CareFirst, an affiliate of BlueCross. If BlueCross covered that clinic 3 years ago, telepractice should be covered for individuals by now, right? Well, I called and sure enough, they had never heard of it, they put me on hold for a while and then told me it was not covered. I asked if there was an easy way to look this sort of thing up via internet in the future. No dice. Nor would there be any sort of announcement when it IS covered. So I just have to keep calling back and crossing my fingers that it will be covered someday. I cringed to think of how many people are missing out because their insurance doesn’t cover this need. However, perhaps growing acceptance for telepractice and the case in Virginia show that BlueCross will come around soon.

I later called Lifewise, which is an Oregon local insurance company. The nice man on the phone was also unfamiliar with teletherapy and had to go on a fact-finding mission to figure out if it was covered. And guess what? It is indeed covered! But he did say that it would have to be coded correctly so it’s best to call prior to receiving speech therapy online in order to make sure it can be correctly justified and covered.

So, my takeaway from these two calls? Private insurance company coverage for telepractice is a mixed bag.

STATE PROGRAMS

Medicare, which is a state run social program that provides health insurance for people over 65 and some people with disabilities, does not cover online speech therapy as of now in any state. The program covers some telemedicine (a doctor or other health practitioner evaluating and treating their patient via videoconference) but as of now speech therapy online is not considered “medicine” and is therefore not covered. Bummer.

Medicaid is a social program for individuals with limited resources that is also run by each individual state. Therefore, Medicaid in Washington might cover a completely different set of services than Medicaid in Mississippi. The American Telemedicine Association put out a report entitled, ”State Medicaid Best Practice” in January 2015 that stated:

Other restrictions can include not allowing the client/patient to receive services at home. Instead, they may have to travel to a medical office and log on to a computer there for it to be considered legal and covered by Medicaid.

The report ended with a recommendation that all states follow the example of Virginia, New Mexico, and Kentucky because their programs are written to be the most inclusive of telehealth services thus far. However, there are restrictions here too. For example, in Kentucky the SLP must be “employed by a physician, home health agency, hospital outpatient department or nursing facility” so an independent contractor could not provide this service to a patient on Medicaid.

So what does ASHA say? Well, here is a helpful map that outlines the states covering speech therapy online and their restrictions. Thank goodness for this map! But the fact that we need a map with a multicolored key to show us this information displays just how confusing the state of reimbursement is right now. And you’ll notice that many states are grey. My advice to “just call” still stands. It really is best at this point to research what is relevant to you in the state you’re in.

ON AN OPTIMISTIC NOTE

In sum, coverage for this important service is spotty and not easy to track. Thankfully, many people are lobbying to get these services mandated in all 50 states and by more insurance companies. ASHA is at the forefront of this fight and by this time next year, more insurance companies and states will hopefully catch up with the times. Several years ago this type of service wasn’t covered by any insurance companies or state programs, so we really have come a long way. And the fact that demand for speech therapy is still so high means that policies need to change to make teletherapy more affordable. For now, best of luck with your fact finding calls! And let us know if you find out anything different than what I did!