We at the William James College INTERFACE Referral Service are keenly aware of the shortage of mental health providers of color and how racial inequities exist in medical and mental health care. The College’s Black Mental Health Academy, Center for Multicultural and Global Mental Health, and other programs and academic offerings are playing a critical role in reversing this trend. We invite you to read a statement from our Black Mental Health Graduate Academy Scholars, and to stand with us as allies to drive change and address systemic racism.

Client Guide to Teletherapy

What is telemental health?  How is telemental health/teletherapy different from traditional “in person” therapy?

  • Teletherapy is the online delivery of speech, occupational and mental health therapy services via high-resolution, live video conferencing. Teletherapy sessions are very similar to traditional speech, occupational therapy, or mental health sessions with one major exception. Instead of sitting in the same room, individuals and providers interact via live video conferencing. 
  • During therapy sessions, the individual and provider can see, hear, and interact with one another in real time, using webcams and headsets.
  • If you have ever used Skype on your computer or FaceTime on your iPhone, you have used a similar type of technology.
  • The actual therapy is the same as the provider would deliver face-to-face, only teletherapy is delivered via an electronic platform. Licensed providers use traditional therapy techniques and activities, enhance those techniques through innovative software and tools, and have the technology literally at their fingertips to plan and deliver high-quality services. Learn more here.

How long has teletherapy been around? Does it work?

  • Teletherapy has been used successfully since the late 1990s for hundreds of thousands of therapy sessions across the United States. It is an effective and appropriate therapeutic delivery mode, based on 20 years of research by over 40 academic published studies.

Is teletherapy covered by my insurance?

  • Private: Insurance coverage for teletherapy varies considerably from state to state, and by insurance plan.
  • Medicaid: Many state Medicaid plans cover teletherapy.
  • Medicare: Medicare has waived many of its restrictions on telehealth during the COVID-19 Public Health Emergency. This means that Medicare will cover teletherapy regardless of where the patient is located or whether the visit takes place in the home or at a health care facility.https://iocdf.org/covid19/teletherapy-in-the-time-of-covid-19/
  • Given the current situation of COVID-19 and social distancing practices, teletherapy services should be covered by insurances.  However, we recommend you contact your insurance carrier(s) to confirm this is a covered service before engaging in teletherapy sessions.
  • Generally, providers should be licensed in the state where the client is receiving services, in order for the coverage to be effective.  If you are traveling to a different state and your provider is not licensed in that state, you should check with both the provider and insurance carrier as to whether or not services would be covered.
  • Due to the current COVID-19 nationwide public health emergency, providers may not currently be required to be licensed in the state in which the client is receiving services.

What about confidentiality?

  • Generally, all transactions and data communication must comply with the Health Insurance Portability and Accountability Act (HIPAA). For more information on HIPAA and electronic protected health information (EPHI) compliance, please see: hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html. 
  • Due to the current COVID-19 nationwide public health emergency, HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that are serving clients in good faith through everyday technologies, such as FaceTime or Skype.  For more information about HIPAA during COVID 19 visit here.

Preparing to start Teletherapy

Questions to ask your insurance company:

  • Is there a copay or session limits?
  • Are teletherapy services covered under my specific plan?
  • Will I pay a reduced fee since it is not “in person” therapy?
  • You can learn more about Medicare coverage here.

Questions to ask a provider:

  • Where are you located? Do I have the option to meet with you in person if I prefer to do so in the future?
  • How do I schedule/reschedule my teletherapy appointments?  
  • How long is each session? Teletherapy sessions should be the same standard time that an in-person session is scheduled for, unless otherwise discussed between the provider and client. 
  • Do I need special equipment to talk to a provider?  The provider should inform the client what digital platform will be used to provide teletherapy services.
  • Are sessions recorded? Unless this has been agreed upon with a formal consent process prior to the beginning of each session, teletherapy sessions, like traditional in person sessions, should never be recorded without a client’s permission and consent. 
  • If I need to have an emergency session while traveling, what should I do? 
    • Generally, emergency services via teletherapy are only focused on crisis management and advising the client on how to access nearby emergency care.  In Massachusetts, clients can contact their local Emergency Service Program at 877-382-1609 which are still providing coverage during the COVID 19 public health emergency 24 hours a day, 7 days a week, 365 days a year.

Getting Started

Once you have confirmed that teletherapy is covered by your insurance and decided it will work well for you, here are some tips for how to prepare at home:  

  • Most laptops/desktops should work fine for teletherapy, and many smartphones will work as well.  However, check your technology in advance of your appointment.
  • Chrome/Firefox will work better than Safari or Explorer. You will want to make sure that your volume is up and that you use earbuds/headset for additional privacy.
  • Provide your therapist with your current location, as well as any support people you have located in the same area as you are, in the event of a crisis.  Also, provide your phone number in case of a lost connection.
  • Make sure that you have a quiet, private place to meet with your provider via telehealth. This may mean setting up in a home office, your bedroom or even in your parked car outside if you live with others. It can be helpful to set up rules with those you live with so you will not be disturbed during sessions.  You could also try to set up a fan or white noise machine outside your room for added privacy.   
  • The goal is to be comfortable and private so as to be able to focus on your well-being.

Sources:

  1. Kelley, T. (2017, April 13). ‘Telemental’ health is becoming the norm. Managed Care. Retrieved from https://www.managedcaremag.com/archives/2017/4/telemental-health-becoming-norm
  2. Langarizadeh, M., Tabatabaei, M., Tavakol, K., Naghipour, M., & Moghbeli, F. (2017). Telemental health care, an effective alternative to conventional mental care: A systematic review. Acta Informatica Medica, 25(4), 240-246. doi: 10.5455/aim.2017.25.240-246
  3. Maheu, M. M. (2018, October 30). Is it legal to practice across state lines with online therapy, telemental health and telebehavioral health? Telebehavioral Health Institute. Retrieved from https://telehealth.org/blog/practice-across-state-lines
  4. Zur, O. (n.d.). Telemental health services across state lines. Retrieved from https://www.zurinstitute.com/telehealth-across-state-lines