TELEHEALTH COVERAGE CAMPAIGN:
Patient and Therapist Scripts
You’re allowed to advocate for yourself when it comes to your coverage. Especially now when circumstances that exacerbate and impact your mental health are unfolding every day – you have the right to be healthy. As you can imagine times are very tough right now and not having access to my therapist and online therapy is making things harder. Help reduce the burden on other health care providers by allowing me to continue seeing my therapist as I require medically necessary mental health care.
Given the current status of Covid-19 and difficulty with conducting services in-person, this is a major concern that I would like to discuss with you and see what can be done about this? I can be reached at (insert email address and phone number) and looking forward to hearing back from you. Therapy is a necessary service, and treatment keeps patients stable and out of urgent care units and emergency rooms – freeing up space and keeping our first responders, doctors, clients, and patients safe.
State Dept of Insurance Steps For Providers
- Call your state department of insurance and speak with a caseworker – get their name and contact info. They will direct you to fill out a complaint form.
- Go to your state’s department of insurance website and fill out the complaint form. Be sure to include specific documentation of any denied claims.
- Follow up with you caseworker with an email (see below)
Call/Email Script for Providers
Hello (Insurance Rep’s Name),
This is (Clinician’s Name) with (Practice Name). I was calling [or emailing] to make you aware of an issue that we’re running into with regards to teletherapy appointments for our mutual clients and the service being denied. Given the current status of Covid-19 and difficulty with conducting services in-person, this is a major concern that I would like to discuss with you and see what can be done about this? I can be reached at (insert email address and phone number) and looking forward to hearing back from you. Therapy is a necessary service, and treating our clients; giving them access to assistance keeps them stable and out of urgent care units and emergency rooms – freeing up space and keeping our first responders, doctors, clients, and patients safe.
Follow-up Email: if they get back to you
Hi (Caseworker’s Name),
Thank you for the helpful conversation this morning. In looking over the complaint process for providers it looks like we need to display evidence of specific claims and members. We submitted a complaint form and wanted to follow up with further information.. We’re basing our concerns on the following:
1)We are credentialed providers for (insert insurance company)
2)Our (insert insurance company) clients have Telehealth/Teletherapy benefits
3)(Insurance company name) issued this in a recent Administrative Bulletin (Ex. of recent bulletin attached – be sure to insert your own if you have them):
Telehealth Network Reimbursement Policy
☒ Traditional and Comprehensive ☒ POS ☐ Medicare Advantage PPO
☒ HMO ☒ PPO ☐ Medicare Advantage HMO
The following information applies to Telehealth Service providers only.
(Insurance Company) remains committed to the delivery of quality and affordable care to our members and continues to diligently evaluate ways to help improve quality of care. Effective February 1, 2020, (Insurance Company) is instituting a network-wide telehealth payment policy to pay providers for telehealth services.
Administrative Bulletin: 2019–12–002
For our non-Medicare Advantage populations only, this new (Insurance Company) payment policy allows any state licensed provider, who has telehealth capability, to provide Covered Services, and (Insurance Company) will pay for services billed under the codes outlined in the policy.All telehealth services are subject to criteria set forth in the new reimbursement policy and other (Insurance Company) applicable reimbursement policies referred to within this policy for dates of service on and after
February 1, 2020.
(Insurance Company) reimbursement policies are created to reimburse for services furnished in accordance with nationally recognized standards and delivered in the most cost-effective way that meets the member’s medical needs.
*All of these items seem to apply to us as providers and our (insurance company) clients
4)(Insurance company) provider support has told providers we know that this does not apply to Licensed Professional Counselors.
Is this enough information for us to move forward or do we need additional evidence?
Thank you for your help!