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The insurance and billing aspect of telebehavioral health

With countless changes to practice and billing in telehealth since the COVID-19 pandemic began, the American Counseling Association (ACA) has provided telebehavioral health insurance and billing tips that may stand the test of time. Namely, the ACA recommends:

  1. Collecting the following from prospective patients: insurance plan information, whether they hold a second insurance plan, and if there are any “medical necessity” issues present.

  2. Contacting prospective patients’ health insurance to check: if the insurance plan is active; what authorizations, service limits, copayments or deductibles come with the plan; what portion of the payment the patient will be responsible for at the time of service; how the insurance plan wants sessions documented; how much of the clients’ deductible has been met; what the Usual, Customary, and Reasonable (UCR) fee is if provider is “out-of-network”; and confirm the “out of pocket” maximum.

  3. Document information from the call to the health insurance company (time, date, content of call, & insurance associate’s name)

  4. Relay and review coverage with clients at time of each service and have clients sign a financial responsibilities contract. Collect copayments, co-insurance, or cost-sharing fees at time of each session.

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