Reimbursement for Telehealth Services

Many children’s OT and speech and ABA services are available via teletherapy platforms. Families have reported finding both challenges with technology (hello, Zoom!) as well as benefits (goodbye, drive time!). If you're among the lucky ones for whom teletherapy is happening, and happening well, here's what's coming — superbills!

Superbills you submitted for out-of-network teletherapy reimbursement get processed through the various insurance company claims departments. Here is what we know:

• Anthem Blue Cross, Blue Shield, Cigna, Aetna, and Kaiser (among others) announced the inclusion of OT, PT,  Speech, and ABA providers to the list of approved telemedicine practitioners for a limited timeframe linked to the Covid-19 pandemic. This applies only to plans that carry existing telehealth benefits.

• Changes to billing codes for teletherapy sessions of OT and speech vary from service to service and insurer to insurer.

Here are some general guidelines for claims processing:

• FILE IN THE KNOW! Log in to your health plan’s member portal and check the benefits section to make sure that your plan includes coverage for telehealth. If you are still unsure, you can ask a customer service representative via live chat, if this is an option on your plan, or by good old telephone.

• FILE WISELY! It is more important than ever to create complete and correct claims. Don’t make avoidable errors that will only serve to compound the uncertainties of processing teletherapy claims. Complete claim forms fully, and don’t forget to date and sign!

• FILE SAFELY! Explore options to file online via the health plan website or via fax to expedite processing and to avoid making trips to the mailbox. And be extra vigilant to monitor claims online to ensure that they are indeed pending in the system.

• STAY PATIENT! Providers are working with the best billing information presently available, but some claims may require a bit of trial and error reprocessing with the health plan.

• REQUEST EXTENSIONS FOR EXPIRING AUTHORIZATIONS! If it is time to pre-authorize sessions, you can request an extension of an existing authorization for services until in-person evaluations can be performed. This is a good tactic, especially with services that you are not certain would be renewed.

If you have them, please feel free to share success stories on your processed teletherapy claims.