Can’t use video for a telehealth appointment in Missouri? Insurance might not pay up | Opinion
Children’s mental and behavioral health has been a top headline for the past several years and for good reason. Research has shown increasing challenges for young people, with suicide, depression, anxiety, disordered eating, obesity, trauma and social media use. Many of us don’t need the news to tell us what we can see in our own homes, schools, churches and neighborhoods.
As a pediatric psychologist, I have also witnessed it firsthand.
So, imagine the worrisome experience when you realize your child needs help, but none is available nearby to you. Or even if it is available, it is still inaccessible because you can’t leave work in the middle of the day to drive your kid to it. Perhaps your transportation options are unreliable. Then what? Are you stuck leaving your children to get sicker, or maybe even to attempt to harm themselves?
This is where audio-visual and audio-only telehealth can be such an asset. The COVID-19 pandemic allowed health care providers and institutions to embrace this electronic health care delivery option fully. Today, many providers and patients alike have discovered how beneficial it is, including young people. Many youths are digital natives, so receiving health care via phone or computer is natural for them. In fact, a study conducted with young people who have experienced abuse or trauma in Missouri indicated that their relationships with their providers and their therapy outcomes were just as good using telehealth as in person. And many of them actually preferred audio-only telehealth sessions, because it was more comfortable for them to discuss their scary experiences with the camera off.
However, there is a dirty little secret. With the end of the pandemic state of emergency permissions, current law in Missouri legally protects ongoing insurance coverage for telehealth only when video is included — not when it is audio-only. While video is often the ideal, it is dependent upon capabilities of internet bandwidth and technology, which are limited and variable across the state.
As a psychologist who fully switched over to telehealth in 2020, I have lost count of how many appointments with my patients have started including video, but ended as audio-only because of tech limitations. Even a location with solid broadband can be negatively impacted by something as simple as bad weather.
Without the legal protection for audio-only telehealth, if a video stream is interrupted, the visit would no longer be covered by insurance. This creates the lose-lose of a parent suddenly becoming responsible for the out-of-pocket cost, or the provider going without the payment necessary to keep the practice open. All the while, the insurance company keeps the change.
Medicare and Medicaid in Missouri have ensured protections for the payment of audio-only telehealth, but commercial and private insurance has not.
Concerns such as this are one of reasons the Speaker of the Missouri House of Representatives, state Rep. Dean Plocher, has identified a priority of protecting access to health care in this year’s legislative session. Fortunately, Kansas City lawmakers are helping with those bipartisan goals. State Rep. Patty Lewis and state Sen. Lauren Arthur have filed bills (H.R. 1873 and S.B. 931) that update the current telehealth protections to include audio-only care.
It is crucial that audio-only protections become law so that our young Missourians can have as many avenues as possible to access mental and behavioral health support.
Amy R. Beck is a pediatric psychologist living in Kansas City, with many years of experience treating children with mental and behavioral health challenges in Missouri. She is the unpaid legislative chair for the 501(c)(6) nonprofit Missouri Psychological Association.
