Counselors, therapists ask insurance companies to cover telehealth past stay-at-home order’s end


AP Photo/Charles Rex Arbogast

In this March 30, 2020, file photo, a public service message reminding people to Stay Home Save Lives is seen on a billboard near the Dan Ryan Expressway in Chicago. Illinois Gov. J.B. Pritzker on Thursday, April 23, 2020 extended his stay-at-home order through May 30 as the highly contagious COVID-19 continues its rounds. Pritzker’s first decree was to expire April 30.

COVID-19 is taking a big toll on our healthcare system, and some Chicago mental health providers say insurance companies aren’t doing enough.

“I opened a practice to serve people, and my biggest barrier to doing so is the insurance companies,” said Dr. Stephanie Grunewald, founder of Restorative Counseling near Millenium Park.

Among the toughest obstacles for mental health providers in recent weeks – who pays for telehealth sessions?

Coronavirus lockdowns have pushed people with mental health risks away from their therapists’ offices, often isolating them in their homes. For many, teletherapy is the only way they can safely get the care they need.

But for those with private insurance through companies like BlueCross BlueShield of Illinois, teletherapy coverage wasn’t guaranteed until March 19, when Gov. Pritzker issued a stay-at-home order.

However, BlueCross only committed to covering those sessions for the duration of Pritzker’s order, so when April 30 approached — the order’s end date — many Chicago-area mental health practitioners scrambled to pressure the insurance company to extend coverage.

BlueCross later announced they’d extend telehealth coverage until May 31, but some counselors and therapists say these short-term extensions just aren’t good enough.

“We haven’t gotten a notice about whether or not [BlueCross BlueShield of Illinois is] going to continue to cover it after May 31,” said Chicago-area licensed clinical professional counselor Karen Rothstein Pineda. “They have extended it with the governor’s orders; however, we still don’t know for sure what’s going to happen after May 31.”

While some states have begun to re-open, public health officials have warned that the period of risk will likely last most of this year, at least. Grunewald said BlueCross’ current cut-off date of May 31 is “absolutely” insufficient.

Originally, BlueCross offered telehealth coverage, but only through a third-party company called MDLive. The problem, said Grunewald, is that MDLive didn’t allow group practices like hers and Pineda’s to use its platform.

MDLive has since lifted that restriction, but Pineda said it’s a moot point: MDLive no longer accepts new care providers.

“We’ve been offering teletherapy services for three years now,” Grunewald said. “It just was never available to BlueCross BlueShield members, because of their own MDLive restriction.”

Access to mental health care is more important now than ever. Dr. Jeff Lanfear, director of University Counseling Services at DePaul, said the school’s counselors made the switch to online therapy as quickly as possible.

“Years of behavioral science research indicates that social isolation and financial stress are two of the most common reasons people are likely to feel distressed,” he said in an email interview. “During a public health crisis, it is critically important that those receiving mental health services continue to do so until they can safely be seen in-person.”

Previously, DePaul’s counseling services charged a five dollar fee. Since campus closed, however, students can talk to the university’s counselors online for free.

As of 2018, there were 57.8 million Americans living with addiction and/or mental health disorders, according to the Substance Abuse and Mental Health Services Administration.

Experts say this number will only rise with the isolation and stress that comes with a pandemic. In a recent poll by the Kaiser Family Foundation, a nonprofit focused on health issues, 45 percent of American adults reported worse mental health since COVID-related social distancing began.

Lanfear said students have felt the impact, too. An April survey by Active Minds, a mental health nonprofit, found that 20 percent of students reported significantly worse mental health under COVID-19.

“We’re going through basically a mass trauma,” Pineda said. “If you already have issues with mental health, this is going to make it worse. But also, this is triggering a lot of people who haven’t had issues before.”

If BlueCross reverts back to its pre-lockdown MDLive restrictions once the May 31 deadline passes, many patients will once again need to either pay out of pocket for telehealth, or seek in-person mental health services. But that could still be dangerous — for therapists, as well as their patients.

“I think a lot of people would be very hesitant to go to an in-person session,” Pineda said. “I’m afraid to bring my son to the doctor at this point for a wellness check.”

Pineda, who is one of two immunocompromised people working in her clinic, said many of her patients also suffer from weakened immune systems.

“Our offices aren’t really equipped to provide in-person therapy in a safe manner,” she said. “If we’re not able to provide telehealth, we can’t treat them.” 

But since BlueCross BlueShield is covering telehealth during the pandemic, Grunewald said there’s no reason the company should stop, even after stay-at-home orders are lifted. 

“I think it’s really unfortunate that the insurance provider would get to dictate whether or not we can continue doing something that’s been working without issues,” she said. “We’re stuck in the middle of this tug-of-war between trying to offer the services we know our clients need, and being told what we’re allowed to do by a big insurance conglomerate who doesn’t understand client care.”

She said more often than not, society’s most vulnerable people are the ones put at risk, since they typically have insurance plans with no telehealth coverage — if they have health insurance at all.

“You feel so hopeless when somebody’s sitting there saying ‘I’ve lost my job, I’ve lost my coverage, I’m suicidal,’” Grunewald said. “And it’s like, okay, well obviously we’re going to keep seeing you, because we can’t just have you drop.”

Treasury Secretary Steven Mnuchin expects the fallout from social isolation to continue pushing unemployment up. And some experts are saying this will put an even greater strain on mental health care in the coming months.

Both BlueCross BlueShield of Illinois and MDLive have not responded to requests for comment.