An Open Letter to Insurers

During the coronavirus disease 2019 (COVID-19) pandemic, the rift between available mental health benefits and the need for mental health and substance abuse counseling services has grown exponentially. Coverage for these services in a traditional, face to face setting has often been inadequate to address the needs of individuals. At a time of increased stress, anxiety, fear, depression, financial instability, and general overwhelm, people have suddenly found themselves unable to continue receiving the necessary emotional and mental health support they need due to insurance providers denying coverage for telehealth (online) counseling sessions. If allowed, individuals would be able to continue counseling during shelter-in-place and social distancing orders.


A Matter of Convenience VS Necessity


The desire for  online therapy services is not new due to this current crisis. Over the past two decades, the demand for greater access to online counseling resources has grown noticeably. In recent years, more clients have begun requesting online counseling sessions. This may be due to travel distance between home and a counseling office, work schedules, or perhaps just preference. Whatever the reason, more clients want online counseling services in order to minimize travel, increase appointment flexibility, and continue seamless care when schedules change. This leads to an increased need for insurance companies to cover the needs of the insurance persons.


What started as a convenience-based demand has now become one that is directly related to dire need. People who are struggling with mental health and substance abuse are now finding themselves isolated from their support networks, possibly facing serious financial hardship and, without the insurance coverage they need for continued therapy services online, they find themselves without the necessary healthcare resources.


Debunking Reasons for Insurance Coverage Denial


Still, many insurance providers continue denying coverage for telehealth therapy services citing that these online counseling services do not offer the same level of care as traditional therapy in a face to face setting, that counselors cannot ensure the person they’re interacting with is the covered patient, that patients can’t be sure the person they’re talking to is their therapist, and a whole host of other concerns.


While some of these issues are valid in certain circumstances, the counseling field has had more than 20 years using a host of online resources and tools while ensuring that both synchronous and asynchronous therapy support can be offered safely, privately, and effectively within the strict state-by-state licensure regulations. Licensed counselors and therapists have master’s degrees, or higher, and training in numerous treatment modalities many of which include online counseling. Some states such as Arkansas even require a specialization or additional certification top top of licensure  in order to provide online counseling. This ensures that counselors can offer services that are equal and comparable to services offered in an office setting with those available through in-office sessions.


The concerns presented by the insurance industry related to identity have been addressed adequately through the requirements for counselors to take necessary steps to ensure identity by requiring clients to provide proof of identity. If clients are under the age of 18, verification is obtained from the parent or guardian and a school ID (if available). Whether patients are in the office or engaging in a video session, counselors take confidentiality very seriously and follow federal regulations regarding confidentiality as determined by HIPAA.


Insurance Response to COVID-19


In the wake of the COVID-19 pandemic, therapy professionals and other medical care providers are attempting to offer an increased number of services via synchronous online video chats and asynchronous communication like email and text messaging. It is in the client’s best interest for insurance providers to offer coverage for these services, but many insurers are denying coverage for these services or taking steps that seem beneficial for clients but actually negatively impact the healthcare providers.


Specifically, some insurance companies are waiving copays and deductibles. While this seems great for patients, it negatively impacts healthcare providers and employers, which leads to higher out of pocket costs for individuals and doesn’t take any money away from the insurance company. The insurers are waiving copays that are part of the money that should be given to healthcare professionals. Then they are often denying all or part of coverage claims for these services, leaving patients owing more out of pocket, clinicians receiving less, and insurers profiting off a pandemic. Additionally, waived copays and deductibles may benefit the individual client but who is eating this cost? Not the insurance company! It’s the mental health provider who suffers this financial loss.


Urgency of Need – Necessity of Insurer Accountability


In the past few months, the world has experienced an unprecedented event – a global pandemic. The majority of the U.S. population has been instructed to shelter-in-place at their residence. Some have even been ordered to do so by the government and are being policed for compliance. Whether you watch the news stations or social media, you will find minute by minute coverage of COVID-19 illnesses, deaths, treatments, and research. COVID-19 has begun to consume every aspect of our lives, resulting in most individuals spending significant amounts of time at home. This pandemic has led to most counselors providing exclusively online therapy services.


So, insurance companies, why are you still not reimbursing, or reimbursing for a lower rate than an in-office session? Counselors still have the same amount of education and the same expenses as they had three months ago, and maybe even increased expenses related to HIPAA compliant online therapy platforms, phones, and fax machines not previously used. Counselors find themselves working more hours than before due to technology limitations or scheduling conflicts. Why do you expect us to be paid less or not at all?


We do not know how long this pandemic will last or how it will affect the overall mental health of many individuals. Counselors and clients must begin to utilize technology in order to “flatten the curve” as the media has stated. In the Journal of Emergencies, Trauma & Shock, researchers reported 14% of recovered COVID-19 patients tested positive again after they were previously determined to be free of the virus. We do not know what this means for the rest of the world, but we do know that there is a necessity to stay in our homes and reduce exposure. Refusing to pay for online counseling or even reducing the payment for online counseling could potentially lead to counselors feeling forced to risk their own health or the health of their clients by continuing to provide face-to-face counseling sessions, abandon insurance clients, or ask clients to pay cash for services their insurance companies claim to pay!




Counselors are obligated to “do no harm.” Please do not ask us to violate our codes of ethics by abandoning our clients or risking their health. Our clients will risk their mental health symptoms becoming worse or new mental health symptoms developing during this time of social isolation. The risk of domestic violence and child abuse increases when families are under stress of loss of employment. Counselors need to be able to provide our services with continuity of care.


We have no problem offering pro bono services, but it should not be because a client who pays for insurance coverage is not approved for the necessary service of online counseling. Online counseling has many benefits outside of the current pandemic for clients in rural areas, with limited access to services, clients who work from home, or those who travel often. Online counseling should always be an option for clients. There is much research to show the benefits and fidelity of online counseling, and insurers should uphold their responsibility to protect patients’ best interests by covering telehealth sessions.


Kristy Burton, LPC, AADC, SAP, NCC, TA

Arkansas Counseling & Wellness, PLLC



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