How Does Online Therapy Work?

Telehealth is a form of health that delivers services to consumers who are remote from the provider. Rather than meeting in person, the client and provider are connected via a phone or computer. Interactions are either real time audio or video sessions or through email and messaging. Convenience for clients and efficiency for providers make online mental health therapy an attractive option along with other forms of telehealth services for people who are busy or have barriers to traveling to an office. Although quickly growing in popularity, the field is new and evolving. You might not know where to start if you’re contemplating using online health services. This post offers an introduction to online therapy to help you be an informed consumer.


How do I find an online provider?

People connect with telehealth services via their insurance network, telehealth service platforms, and private providers. Over the past few years, insurance groups have piloted telehealth programs and now many big payers, like Aetna, Cigna, and Blue Cross Blue Shield, reimburse for telehealth. Not all insurance plans cover telehealth and there are different policies across the industry that affect how a client can access telehealth. State and federal programs including Medicaid and Medicare have different guidelines from commercial plans.

Medicaid plans generally follow Medicare rules in regards to telehealth reimbursement. At the present time, Medicare will reimburse for outpatient behavioral health services but only if the person resides in a service area designated by Medicare programs to be outside larger, urban areas. You can research this online to find out if you are in one of those areas. If you are, you could be reimbursed for telehealth services. Be aware that Medicare will only reimburse if the recipient is in an office which has a live staff person who helps them connect to the remote provider. That means you can’t be at home at the time you receive the service. Medicaid plans have been mostly following the Medicare rule. Hopefully this will evolve in the future to facilitate greater access by people covered by government-sponsored plans.

Many commercial insurance plans provide telehealth benefits. Unlike Medicare, commercial plans have not been limiting where the recipient can be located when receiving services. You can call the customer service number on the back of your card to find out if your plan covers telehealth services which include behavioral health. Some plans require that the telehealth service be provided by someone who is not only in-network for the plan but also credentialed on their telehealth platform. If your plan covers telehealth services, your reimbursement will typically follow the same scheme as if the service were provided in an office. That is, your copay would be the same and the paid amount would count toward your deductible.

So, if you have insurance coverage, the first step would be to call your customer service to ask about the telehealth benefit. An alternate plan would be to connect with one of the online telehealth platforms, such as MeMD or MDLive, which serve private pay clients as well as those with insurance reimbursement. In that case, they can submit the claim for you. Be aware that some insurance plans only use one platform so starting with your plan’s customer service is the safest route in regards to limiting your out-of-pocket expense. There are two options for people who don’t have insurance coverage for telehealth services.

Subscription plans from services such as Betterhelp and Talkspace range from $40-80 per week and provide the user with a combination of messaging and live sessions with a credentialed therapist. None of that fee will be reimbursed by an insurance plan. The two most attractive features of these plans would be the lower out-of-pocket expense and the emphasis on messaging. Messaging is a format that is desirable for a lot of people and a component that hasn’t been an element of conventional therapy. While these subscription services offer a more affordable rate for regular meetings supplemented by frequent messaging, the online reviews suggest that quality is compromised. This is because the reimbursement rate to the provider for a relatively high amount of contact time is low. Therefore, these companies can hire and retain only therapists working at the bottom end of the pay scale. I suggest you research these reviews carefully before making a commitment to working with such a service.

Many private providers like me provide online services through their private practice. Individual online therapists can be found through therapy listing sites such as Theravive and Psychology Today and are efficient ways to locate a therapist who is credentialed in your state. Be aware that Google searches and browsing listing sites will produce limited information since Google shows results based on a complex algorithm and not all therapists list on all listing services.


Does online therapy follow the same guidelines as in-person therapy?

All forms of online mental health therapy follow the laws and rules that apply to direct, in-person service delivery. Providers must be credentialed in the jurisdiction where the recipient is located at the time of service. For example, since I am licensed in Indiana, I can provide an online session to someone as long as they are in the state during the time of the session. I would not be able to legally provide that session if the person were in Ohio. As a provider, I can be anywhere at the time of the session. Coaching services can be delivered to anyone anywhere since it is not considered mental health treatment. In my case, I provide wellness and coparenting coaching to clients who are located outside of Indiana. But, if that person presents with a mental health issue which warrants treatment (for example, clinical depression), I would refer that person to a credentialed therapist in their jurisdiction. Be aware that not all therapists follow this rule even though legally they should. A lot of therapists skirt the law by using the term coaching when they are really marketing therapy services.

Confidentiality is of highest importance for online work as it is with in-person practice. So, video-conferencing platforms must be private and secure in order to be compliant with privacy laws. Electronic communication and record-keeping are also controlled in the same manner. Privacy for online services is more complicated than services delivered in an office setting since the provider has little control over where the recipient is during the connection. Providers do recommend that as a recipient, you choose a quiet place where you can have a private interaction with your therapist. That would mean avoiding connecting while you’re in a crowded, public space.


Do I need special equipment or software?

Most online portals work without installation of any additional apps or software if the user is accessing services via a laptop or desktop computer. If you will be accessing the therapy via your phone or tablet, it’s likely you will need to first install an app. You will also need a sufficient internet connection. When you connect with a provider or service platform, you will get instructions about how you can connect. This aspect of telehealth has improved in the past couple of years so that the steps to establish the online connection have become quite simple.


So, what are the pros?

So far, studies have shown that clients find online therapy about as satisfying as in-person services. Online sessions are much more convenient because they can happen when and where the client prefers. Hassles of traveling to an office are removed. Clients who have resource issues, physical debilitation, or mental health issues (such as loss of energy, agoraphobia, or social anxiety) can still get services. Many providers are now available to wider geographical areas than they ever would have been able to be through their conventional practice. So, many people in rural areas will be better served. Online services can be accessed at any hour of any day which greatly expands the available meeting times beyond conventional business hours. For people who like messaging, some services provide messaging and email exchanges. Online services range from 50-100% of the cost of in-person services (without figuring in the savings from not having to travel to and from an appointment).


What are the cons?

Some people simply won’t like the lack of face-to-face meetings. While a sufficiently intimate connection can be achieved via messaging and live audio and video connections for effective and satisfying therapy, being connected indirectly is not the same as sitting live in the same room with another human. For some this element would be in the pro category. But, for some people this is a significant detraction. Connective with an online provider is not yet quite as easy as connecting with a local service. In addition to the typical initial communication, there is the extra step of making sure you have a working virtual connection. Some forms of therapy that include more than one client at the same time are more challenging to deliver.


Wrapping up…

If you’re interested in online sessions, check out your insurance provider to see if behavioral health telehealth services are covered and how to access them. If you don’t have such coverage, you can decide whether you want to schedule with a private provider, sign up with a quality telehealth platform such as MeMD or MDLive, or experiment with one of the lower cost subscription plans. If you’re interested in scheduling an appointment with me, click the button below.





Posted by Jon Peters