Reliable remote therapy

February 1, 2021 11:56 AM

I'm asking to help a friend who is in a situation where putting off therapy any longer is going to have drastic consequences. They are immunocompromised and need this therapy to be virtual. How should they navigate this?

A lot of startup companies have popped up over the year or so that offer "virtual" therapy. These are often overpriced, and, or so it seems on the surface, impersonal or "bandaid" solutions for things like general anxiety or situational depression. Friend has serious mental health issues (bipolar, addiction, trauma history, etc) that need a qualified professional to form a (hopefully) long-term rapport with. Friend has insurance through Medicare.

posted by FirstMateKate to Health & Fitness (14 answers total)

I was able to find a therapist in April 2020 by calling and emailing providers in my area and asking about tele/video therapy. My first call was a hit and I’ve been working with that therapist since then. I believe I had to sign a document stating that I was aware that some practitioners consider therapy via videoconference to be less effective than in-person and was willing to consent to therapy despite that, but aside from that, it was pretty trivial. I’m paying out of pocket so I’m unsure how insurance is handled, but I’m certain something exists by this point in the pandemic.
posted by Alterscape at 12:00 PM on February 1, 2021

Best answer: Psychology Today has added a filter for searching for providers who do teletherapy. You can filter by insurance coverage.

My last therapist, who previously was in person only, has added telehealth for the duration of the pandemic, and so have many in my area. Your therapy licensing body (board of behavioral sciences or equivalent) will have information on what is required from therapists in your area in order to provide telehealth; in my state, they need to be licensed in the state and the person receiving therapy needs to reside in the same state in which they are licensed.

Feel free to MeMail me more details if you'd like help finding the licensing guidelines for your friend's state.
posted by assenav at 12:05 PM on February 1, 2021

Best answer: I am in Silicon Valley and every therapist that I know of is offering telehealth right now. A few are also meeting in person but only for a subset of their clients. So I would have the friend pick the therapist in the usual way and contact them. Odds are that they will be doing telehealth. In fact, they should probably have a therapist that is convenient for in-person session eventually - with that kind of long term problems, there will be a lot of value to being able to work in person eventually.

The trickier things will be to find a therapist with an opening - with the pandemic demand for counseling has increase, clients stay longer and therapists who are juggling their own family needs may not be able to take on as many clients. So, expect to have to make a lot of phone calls and don't give up!
posted by metahawk at 12:09 PM on February 1, 2021 [4 favorites]

Best answer: You are right to be suspicious of the start-ups offering telehealth. They pay therapists poorly (even compared to regular insurance plans which usually pays a fraction of the self-pay rate) so you tend to get people who are just starting out and willing to accept such low fees until they are able to build up their practice. Not say that new therapist can't be helpful but I think your friend would benefit from someone with substantial experience.

There is also a serious problem with confidentiality - information about patients is available to a for-profit company that can use it for marketing or data mining purposes.
posted by metahawk at 12:14 PM on February 1, 2021 [1 favorite]

One more thing - don't limit yourself to therapists who advertise as offering telehealth. With the pandemic, most everyone is doing telehealth but either they haven't updated their listings or they don't intend to continue once it safe to be fully back in the office.
posted by metahawk at 12:16 PM on February 1, 2021 [4 favorites]

Best answer: I have some general advice for your friend - Medicare DOES cover telehealth for mental health care now. But lots of mental health practices are still saying that Medicare won't cover mental health telehealth services.

Any office that says they do not are either not up to date on current law and billing practices (in which case I would not trust them administratively to not mess up my billing), or is subtly discriminating against Medicare recipients (in which case I would not want to get treated there).

It's never really worth it to argue with an office before you've even been able to schedule a session that actually, yes, you are covered.
posted by juniperesque at 12:42 PM on February 1, 2021

Best answer: What state is this person in? Seeing someone in the same state is likely easiest and people might be able to recommend specific agencies that take Medicare. I see a therapist through an agency that mostly works with Medicare and Medicaid and we do remote sessions now.
posted by needs more cowbell at 12:48 PM on February 1, 2021 [1 favorite]

Yeah, nearly everyone does teletherapy now, even people who have started seeing clients face-to-face again. If you ask for teletherapy, no one will turn you down at this point. I found my therapist, who's in the same town but whom I've never actually met, via Psychology Today. My wife is also a therapist, and so if we don't have much else to talk about, sometimes my therapist and I will discuss the state of the profession. She believes teletherapy is here to stay even after the pandemic, and she knows someone who actually moved to a different state (Hawaii!) because, with teletherapy, there's no reason you have to stay in one place anymore.
posted by kevinbelt at 12:53 PM on February 1, 2021

Best answer: I'm a psychologist practicing in New York. Every therapist I know is doing telehealth now. Your friend can look on Psychology Today to find somebody, but beware, the "Insurance Accepted" info is not always accurate. You must call or email to see if somebody takes Medicare.

As for kevinbelt's post, as far as I know, I have to see patients only in New York state, because that's where I'm licensed. But I could be wrong. All my patients are in New York State, because they're the same people I was seeing in person before the pandemic.

ONe thing is: the patient rights, including confidentiality, regulations (HIPAA) were suspended for awhile so that we could quickly start doing teleheath. But now they're back. So the therapist should be using a platform that complies with those regulations. So, for example, regular old Skype doesn't, but there's a health professional Skype that does. This might not concern the patient that much or at all -- it definitely would concern a therapist who's billing an insurance company or Medicare -- but it's just something to consider.

One more thing -- it might behoove your friend to find a therapist who's within easy traveling distance, because, who knows? this pandemic MIGHT end! and if they have a good relationship with the therapist, it would be unfortunate to have to quit if the therapist stops doing telehealth. And it's actually possible that a therapist using Medicare might not be allowed to do telehealth after the pandemic is over, if a patient is deemed able to go to an office (just saying -- we really don't know what the future looks like in this (or any other) regard.)
posted by DMelanogaster at 1:03 PM on February 1, 2021 [1 favorite]

Best answer: oh, I forgot to say: instead of (or addition to) looking on Psychology Today, maybe the friend can find a list online of Medicare providers near them and do it that way -- just as most people I know who are insured through a private company will go to the list of providers on the insurance company's website. I don't know if Medicare has this but it's likely they do. Then match with Psychology Today listings, if they have them, to get more information. At least in that way you're assured that the therapist really does accept Medicare (although they may have a full practice or not be taking any MORE Medicare patients, because that's often the Way Of Things).
posted by DMelanogaster at 1:29 PM on February 1, 2021

"As for kevinbelt's post, as far as I know, I have to see patients only in New York state, because that's where I'm licensed"

Yeah, I didn't express what I was trying to say very clearly. The person I was referring to is licensed in Massachusetts and their clients are all in Massachusetts, but there is no longer a requirement for the therapist to be in Massachusetts as well. So they're in Hawaii with a Mass license, seeing people from Mass.

I don't know how sustainable that is long term, but the point is that they're betting on teletherapy being a long-term thing.
posted by kevinbelt at 1:44 PM on February 1, 2021

Perhaps folks here could make recommendations if you shared where your friend lives. As others have said your friend should find someone that can work with in person once restrictions ease.
posted by whatdoyouthink? at 1:47 PM on February 1, 2021

Best answer: Just nthing that you should just proceed as normal to find an available therapist as you would in the beforetimes and expect they are doing telehealth until they tell you specifically that they don't.

Provider listings are always garbage I think, and even personal websites seem to be the last to know if anything changes. Just get a hold of them in whatever manner seems to be working and find out from there if they'll accept the insurance and can do streaming.
posted by Lyn Never at 2:34 PM on February 1, 2021

Response by poster: Friend is in VA - thank you all for the wonderful advice. there's a local therapist (you're right, DM, things may be good eventually!) that's doing telehealth and taking medicaid. This is a big deal for them and a big step! So thank you again.
posted by FirstMateKate at 2:02 PM on February 2, 2021