Some insurers deny claims for mental telehealth services

(MUSIC) JOSH: ONE OF THE NATION'S LARGEST INSURANCE COMPANIES HAS REVERSED ITS DECISION TO DENY A TEXAS WOMAN'S MENTAL HEALTH NEEDS. THE CHANGE COMES AFTER OUR INVESTIGATORS STARTED LOOKING INTO TIPS THAT INSURERS ARE NOT COVERING MENTAL TELEHEALTH SERVICES AMID STAY-AT-HOME ORDERS DURING THE COVID 19 PANDEMIC. INVESTIGATOR JODY BARR DISCOVERED MANY OTHER TEXANS ARE STILL STRUGGLING WITH THIS PROBLEM. GORDON: THIS IS HOW I'VE BEEN SPENDING MY TIME WHEN I'M NOT WORKING FROM HOME. IT KIND OF IS A WAY TO PASS THE HOURS AND NOT SPEND ALL MY TIME ON NETFLIX. JODY: MEGHANN GORDON'S EMBROILED IN A FIGHT WITH BLUE CROSS BLUE SHIELD OF TEXAS--TRYING TO GET THE INSURANCE GIANT TO COVER VISITS TO HER THERAPIST. GORDON: ""DEPENDING ON HOW LONG WE'RE DOING WORK AT HOME, I MIGHT ACTUALLY GET GOOD."" JODY: GORDON HAS HEALTH INSURANCE THROUGH HER TEACHING JOB. SHE NEVER HAD A PROBLEM BEFORE, BUT WHEN HER THERAPIST WAS FORCED INTO PROVIDING SESSIONS OVER A TELEHEALTH PORTAL GORDON SAYS HER INSURER

PUT THE BRAKES ON COVERAGE. WHEN I CALLED THEM, THEY TOLD ME THAT THEY WOULD NOT COVER THAT VISIT, EVEN THOUGH SHE'S A PARTICIPATING PROVIDER AND THEY'VE COVERED IN PERSON VISITS BEFORE."" JB: YOUR INSURANCE PROVIDER IS TELLING YOU, BECAUSE YOU CAN'T SEE YOUR PROVIDER IN PERSON, WE'RE NOT PAYING FOR IT? MG: YES, EXACTLY. THEY'RE ONLY WILLING TO PAY FOR IN PERSON VISITS. JODY: SHE'S REPEATED THIS SAME PROCESS FOR THE PAST THREE WEEKS-- (CLICKING) IN A FEW WORDS, PLEASE TELL ME THE REASON FOR YOUR CALL. MG: ""COVERAGE."" JODY: SHE KNOWS THE AUTOMATED MENU BY HEART-- GORDON: ""THIS IS MY 4TH TIME CALLING ABOUT THIS."" JODY: B-C-B-S TOLD HER ALTHOUGH THEY DENIED HER COVERAGE--HER REQUEST FOR TELEHEALTH COVERAGE IS "IN REVIEW." MG: ""IS THAT STILL IN REVIEW, ARE THEY STILL MAKING A DECISION ON THAT?"" BCBS: ""RIGHT, RIGHT, IT'S STILL IN REVIEW."" MG: ""DO YOU KNOW HOW LONG IT'S GOING TO BE IN REVIEW, I'VE TRIED TO FOLLOW UP EVERY WEEK A COUPLE OF TIMES A WEEK-."" BCBS: ""NO, MA'AM."" GORDON: ""FOR PEOPLE ON SELF-FUNDED OR EMPLOYER-FUNDED PLANS, THEY DON'T REALLY HAVE ANY OPTIONS, IT'S WHAT THE

INSURANCE COMPANY DECIDES TO COVER AND UNFORTUNATELY THEY'RE CHOOSING NOT TO COVER THESE VISITS."" JODY: PROVIDERS TELL US, THE PROBLEMS REST WITH PRIVATE, EMPLOYER-FUNDED HEALTH PLANS. SOME PLANS PROVIDE TELEHEALTH COVERAGE FOR BEHAVIORAL HEALTH--SOME DON'T--EVEN UNDER THE SAME INSURER. ROBERTSON: ""YOU JUST GO ON HERE AND JUST HIT-CLICK VIDEO, START TALKING."" JODY: ANITA ROBERTSON TREATS DEPRESSION AND ANXIETY. AND LIKE MOST OTHER THERAPISTS IN TEXAS--IS ONLY SEEING PATIENTS OVER THE INTERNET RIGHT NOW. ROBERTSON: ""ALL OF THIS IS HIPPA SECURE."" JODY: WITH SO MUCH ISOLATION SOMETHING THAT COULD BE A SUICIDE RISK FACTOR. SHE SAYS PATIENTS NEED HELP NOW MORE THAN EVER. THE BARRIER, SHE SAYS, IS INSURANCE DENIALS. DESPITE THE FINANCIAL GAMBLE SHE'S STILL TREATING THOSE WHO NEED HER MOST. ROBERTSON: ""ETHICALLY AS A PROVIDER, I FEEL LIKE IT WOULD BE UNETHICAL TO STOP TREATMENT JUST BECAUSE PEOPLE CAN'T PAY IN THIS TIME BECAUSE IT WOULD CREATE WAY MORE HARM AND YET IT'S ALSO UNSUSTAINABLE FOR ME

LONG-TERM TO BE ABLE TO SEE CLIENTS FOR COPAYS OR FOR NOTHING."" JB: ""HOW CAN A TEXAN NOT HAVE A PAINTING OF A LONGHORN?"" MG: ""I THINK THAT MIGHT HAVE TO BE THE NEXT ONE... JODY: HOURS AFTER WE ASKED GORDON'S INSURER ABOUT HER CASE--IT REVERSED ITS DECISION--OFFERING FULL COVERAGE THROUGH APRIL. GORDON'S WORRIES--THOUGH-- ARE FOR OTHER TEXANS. A REASONABLE PERSON WOULD ARGUE, IT'S BETTER TO PAY FOR A TELEHEALTH VISIT THAN FOR SOMEONE TO NOT BE SEEN AT ALL. IS THAT FAIR?"" MG: ""YES, I WOULD AGREE. JOSH: JODY JOINS US NOW. SO HOW DO WE STOP THIS FROM HAPPENING SO MORE TEXANS AREN'T DENIED COVERAGE? JODY: WELL, JOSH, EXPERTS IN THE INSURANCE BILLING FIELD TELL ME THE FIX WOULD COME AT THE FEDERAL LEVEL AND IT WOULD COME WITH A CHANGE IN LAW. WE SPOKE WITH CONGRESSMEN LLOYD DOGGETT AND MICHAEL MCCAUL'S OFFICES. BOTH TELL ME THEY'RE WORKING TO FIGURE OUT HOW THIS DISPARITY EXISTS IN THE FIRST PLACE FROM PLAN-TO-PLAN AND WHAT THEY MIGHT BE ABLE TO DO ABOUT IT. JOSH: JODY, THANK YOU VERY MUCH. (SWOOSH) (MUSIC) JOSH: AS COVID-19 SPREADS FASTER IN TEXAS - FRUSTRATION GROWS WITH PEOPLE WHO WON'T

FOLLOW SOCIAL DISTANCING RULES. QUIT BEING AN [EXPLETIVE]. THAT'S MY MESSAGE, CANDIDLY. GET OVER YOURSELVES. JOSH: WHY ONE STATE LEADER SAYS IT'S NOW UP TO INDIVIDUAL TEXANS TO STEP UP AND STOP THE SPREAD OF THE CORONAVIRUS. (MUSIC) This is our home. We've never seen it look quite like this. But there's no mistaking it. And it's our