ONLINE THERAPY AND TELETHERAPY IN SAN FRANCISCO

Does online therapy work and is it effective?

Is online therapy effective?

Yup! A quick sampling of the many findings:

• On its website, the American Psychiatric Association explains that this form of care can be “equivalent to in-person care in diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction.”

• A randomized controlled trial found that online therapy was as effective as in-person therapy in reducing depressive symptoms (Wagner et al., 2013). 

• A study of those who sought online therapy for anxiety, work stress, and relationship problems found that client satisfaction scores were comparable to that of in-person sessions (Murphy et al., 2009).

• A report generated by a workgroup sponsored by the American Telemedicine Association in 2013 states, “To date, no studies have identified any patient subgroup that does not benefit from or is harmed by mental health care provided through remote videoconferencing. Recent large randomized controlled trials demonstrate the effectiveness of telemental health with many smaller trials also supporting this conclusion.”

What are the benefits of teletherapy?

Teletherapy can benefit an individual in many ways: 

• You’re already familiar with the format. You’ve probably been Zoom or a similar platform for work… amirite? 

• You already use technology to communicate. Sharing personal or private information over video can feel more comfortable than when we’re sitting face to face.

• Scheduling is way more convenient.

• Geography doesn’t get in the way. Once you find a therapist you like, job changes and moves can make it challenging to get to their office. As long as you’re within the State of California, online therapy allows you to stick with someone you know and trust.

• It makes therapy more practical, with worksheets and other tools that can be shared during the session. I use the “screen sharing” function on Zoom for Telehealth... Because who wants to be carrying papers around?

A therapist trained explicitly in teletherapy can optimize it further, with methods and techniques specifically designed for the format. I’m a TBHI-Certified Telebehavioral Health Practitioner.

How client data is protected in an online therapy setting

Therapists handle “PHI” or Protected Health Information, which includes demographic or health information about an individual, the provision of therapy, or payment for treatment. 

You’ve probably heard of “HIPAA,” the Health Insurance Portability and Accountability Act. It legally requires us to protect the privacy of your PHI. 

Your therapist likely uses several “systems” or programs that contain PHI, including an EHR (electronic health record) program, a scheduling system, a computer, tablet, or mobile phone, an email service, and perhaps hard-copy paper files. If your therapist’s billing system goes beyond just processing payments and sends invoices or receipts, that includes PHI as well.

Concerning each of these, you’ll want to know how your therapist maintains HIPAA compliance. For record-keeping and scheduling, I use Simple Practice, which is HIPAA-compliant.

With online therapy, you’re adding other “systems” to the mix. What can you do to ensure your data will be safe?

• Ask your therapist what they do to secure devices that contain PHI. For instance, smartphones, tablets, laptops, or desktop computers. At the very least, each device should be password-protected.

• If online sessions are by video, to make sure client data is secure, the video platform should be HIPAA-compliant. Ask your therapist what platform they use.

• Check to see if the video platform uses high-grade encryption services to protect client data. You might find this on the FAQ section of the video platform’s website. 

• Ask your therapist if they’re signed a business associate agreement (BAA) with the video platform vendor. These agreements certify that there are administrative and human safeguards in place to avoid data breaches.

I use a HIPAA-compliant video platform

It’s “Zoom for Telehealth,” which is HIPAA-compliant.

It routes video from person to person (one end of the call to another), making it extremely difficult for nefarious characters to gain access.

Regular Zoom (the free or basic paid versions) routes video through a server, increasing the risk of attacks on confidentiality.

Zoom for Telehealth has multi-layer security

It incorporates access and authentication controls, as well as end-to-end AES-256 encryption of all audio, video, and screen-sharing data.

How much is online therapy?

Fees for online therapy will vary. A few factors to consider:

• The therapist’s full fee. In larger cities, a therapist’s total price may range from $150-200 per session, on average. As you’d expect, more experienced therapists command higher fees. 

• Whether the therapist offers “sliding scale” fees. Some therapists reserve a few “sliding scale” spots in their schedule, for clients in different financial situations. It may be helpful to ask.

• Whether the therapist offers discounts for online sessions. Some do! Again, it’s worth asking.

• Whether the therapist is in-network. For certain types of health insurance, if you’re able to find an in-network therapist, you might only pay a copay, which may be as little as $30 per visit. Your health insurance company’s website likely contains a directory of in-network providers. Unfortunately, in larger cities, it can be challenging to find in-network therapists who have availability. 

• Whether your health insurance covers out-of-network therapists. Many health insurance plans (especially PPOs) will reimburse you at a decent percentage for sessions with out-of-network therapists. Sometimes as much as 60-70% of the therapist’s fee. It’s pretty tricky to find this information online; you’ll likely need to call your insurance company.

Will insurance cover online therapy?

It depends.

Most health insurance plans cover mental health visits. You’ll want to find out:

• What percentage of each visit is covered, for online therapy.

• Your copay (the amount that you’ll pay the therapist directly at the beginning of each visit).

• If there is a yearly limit as to the number of sessions covered;

• Your deductible (the amount you pay before your insurance starts to pay).

• The coinsurance amount. Coinsurance is the percentage of the cost that you’re responsible for after you’ve met your deductible.

Much of this information will be on your health insurer’s website, but it’s often complicated. It would likely be worth your time to call and speak to a live person (the phone number to call is usually on the back of your insurance card).

Some insurance companies only cover in-network therapists, which means that you have to choose from a list of therapists who have contracted with that company. That list is usually on the insurer’s website. Unfortunately, you may have to contact a few of them to see who has availability. 

Other health insurance plans also cover out-of-network therapists, which expands your choices dramatically. Also, insurance companies don’t pay out-of-network therapists directly. Instead, they reimburse the insured (you) for some portion of the fee that you’ve already paid the therapist, usually after you’ve met your deductible. 

For example, if an out-of-network therapist charges $150 for a 50-minute session, and insurance covers 60% of the fee (which some plans do), you’d pay the therapist $150 at the start of the session. The therapist gives you what’s called a “superbill” (a statement of the dates you attended and the fee paid). You submit the superbill to insurance, and they’d reimburse you $90.

Some more questions you’ll want to ask your insurance company, regarding online therapy:

• Whether they require that a specific video platform be used.

• Whether they cover phone sessions, in addition to video sessions.

• What paperwork they require you to submit to get reimbursed.

• Whether coverage for online therapy will continue beyond COVID-19.

Speaking of which, a COVID-19 update:

During the current COVID-19 state of emergency, many states, including California, have directed insurance companies to cover online therapy to the same extent as in-person visits. This includes Medicare, as well. With teletherapy being used so widely during the pandemic, hopefully, this requirement will be extended. 

Some insurers have decided to waive copays for online therapy (remember, copays apply to visits with in-network therapists). Some of these insurers include Aetna, Blue Shield, and Cigna. Here’s hoping other insurers follow suit.

Here’s a comprehensive list of how each major insurance company has responded to COVID-19 when it comes to telehealth (look for the term “behavioral health”).

Why do video therapy during the COVID-19 crisis?

Video therapy can help clients during the COVID-19 crisis in numerous ways.

You’ll learn practical ways to cope with this tough time

Now more than ever, it’s so important to reduce stress and anxiety, to take care of yourself… to feel okay.

You need an objective, grounded source of support

Turning to a loved one feels good, but if they’re overtaxed from dealing with their own stuff, it may be time to get started with a therapist.

You likely have more free time than before

Why not use therapy to relieve stress? Feel less down? Strengthen your relationships? Optimize how you’re living?

It can be as effective as in-person visits

The American Psychiatric Association explains that this form of care can be “equivalent to in-person care in diagnostic accuracy, treatment effectiveness, quality of care, and patient satisfaction.” 

A report generated by a workgroup sponsored by the American Telemedicine Association in 2013 states, “To date, no studies have identified any patient subgroup that does not benefit from or is harmed by mental health care provided through remote videoconference. Recent large randomized controlled trials demonstrate the effectiveness of telemental with many smaller trials, also supporting this conclusion.”

Why do it after this crisis is behind us too?

Scheduling is easier

You can fit therapy sessions into your busy day, requiring less time off from work or whatever else you need to do. Extra bonus: being able to avoid public transit in San Francisco.

Progress is more consistent

If you’re feeling tired or have a cold, or if it’s kinda gross outside, instead of traveling to see a therapist face to face, it’s easier to keep the session.

You may see faster gains

More consistent therapy can help you reach your goals more quickly.

It may be easier for those with social anxiety, agoraphobia, or other anxiety disorders

I know how it is. Walking into a clinic and greeting a therapist who you’ve never met before, answering questions about yourself… It may feel intimidating, especially for the first time. Online therapy may allow you to feel more comfortable. 

If you are interested in online therapy, schedule a free 15-minute phone consultation with Andrew Kushnick, MFT to start your path to feeling good.

Other common questions about online therapy: