Due to the implementation of social distancing guidelines [1] and stay-at-home orders across the US [2], nonessential businesses have closed their doors. That includes private practices run by therapists. At a time where being isolated [3] and the novel coronavirus pandemic itself [4] can cause anxiety and stress — and especially for those with mental illness — not being able to go to scheduled face-to-face therapy appointments is a problem. That's where teletherapy comes in.

Teletherapy is exactly how it sounds. Simply put, it's the act of receiving therapy by phone or video call from a therapist who is licenced in your state. Each state has its own licencing board for therapists, and during this time, some are permitting therapists to practice across state lines — many therapists POPSUGAR spoke to have verified this. It also depends on what type of licence a therapist has. Here is, for example, a state by state rundown of emergency waivers [5] and actions announced, as released by the American Psychological Association.

Some states are also making it easier to get temporarily licenced in order to accommodate therapy across state borders. Sheina Schochet, LMHC, for instance, who's licenced in New York and Florida, said she recently received a temporary licence lasting 180 days to practice therapy in New Jersey [6]. Regardless, those conducting therapy should check in with their individual state's licencing board for more information.

Teletherapy Amid Coronavirus: HIPAA, Insurance, and Growth

Teletherapy and HIPAA

Typically, teletherapy sessions need to be conducted with technology that's compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA); in other words, through platforms that guarantee privacy for the client's information. For instance, my therapist uses a platform called Doxy for video sessions, and there are other services such as Zoom for Healthcare and Updox. Basically, you can't just pull up FaceTime.

"There could be legal trouble in general from not using HIPAA-compliant devices and technologies to use and disclose patient health information," Alissa Smith, a partner at the international law firm Dorsey and Whitney who represents different organisations and workers in the healthcare industry, told POPSUGAR. "Because mental health information is more sensitive and protected, the stakes are higher, and providers should exercise even greater caution to protect the information."

That being said, due to the national emergency declared, HIPAA rules have been waived [7] on telehealth, making it easier to communicate with patients through personal devices and apps that aren't HIPAA complaint such as FaceTime and Google Hangouts. Therapy sessions are included in this, according to Smith. "HIPAA applies to all healthcare providers, so the waivers also apply to all healthcare providers, including therapists," she said. "However, if states have more restrictive privacy and security requirements for mental health and substance abuse treatment providers, then the state law would continue to apply."

That was echoed by Mary Jo Monahan, MSW, LCSW, the CEO of American Social Work Boards, which works with all of the licencure boards throughout the United States and in Canada. If teletherapy rules instated by individual state boards are more restrictive than HIPAA, those rules should be followed, she said. As a regulator, Monahan said she would not encourage any therapist to use technology that is not HIPAA compliant. "If anything, during an emergency when people are distraught and vulnerable, therapists have to be at their best and their most competent and practicing safely," she told POPSUGAR. When in doubt, a therapist should check with their state licencing board during this time though the national HIPAA waivers should apply.

Is Training Required For Teletherapy?

Additionally, in order to practice teletherapy ethically and, as Monahan said, competently, it's generally encouraged to have some sort of training. For instance, Natalie Jones, PsyD, a licenced professional clinical counselor (LPCC) and psychotherapist in California, told POPSUGAR that she received a teletherapy certification through continuing education. Getting extra training in teletherapy is simple for licenced mental health providers to do, Dr. Jones said, "and if not a certification, it's at least in your best interest to be well-versed in the requirements of teletherapy." Note: Dr. Jones said she uses Zoom and Skype business accounts that are HIPAA compliant as well as Google Voice for phone calls, which is also HIPAA compliant.

For therapists who work under behavioural health services like Talkspace [8] and AbleTo [9], for instance, conducting sessions using new technologies is something they go over before working with clients. Talkspace offers video therapy sessions along with text, audio, and video messageing, and AbleTo offers video and phone calls with therapists during eight-week programs, which individuals have access to through their health benefits. Those administering therapy should be checking with their licencing board to see if there are any training requirements specific to their state at this time.

Is Teletherapy Covered by Insurance?

Therapists are not always affiliated with insurance carriers and therefore do not take insurance for their services, so be sure to check if a therapist takes your insurance or not first. If your therapist takes insurance, you will be charged a copay, coinsurance [10], or the full contracted rate if you need to meet the deductible, Dr. Jones said. If you do not have health insurance, you will be paying for your sessions up front in full (out of pocket).

If a therapist doesn't accept your insurance and your insurance company has out-of-network benefits, you will also be paying the full rate out of pocket, but you can send your therapy bills to your insurance company for reimbursement; depending on your plan, your insurance should reimburse up to 80 percent of the cost [11]. Your therapist will give you a form that typically has your diagnosis, their tax identification number, the charge of the session, and a billing code. According to Monahan, there are two separate codes for face-to-face therapy and for teletherapy. These codes are important for reimbursement purposes and they are the same for psychologists, psychiatrists, and social workers giving therapy [12], according to the American Psychological Association.

Whether or not teletherapy is covered — and how much is covered — depends on your individual insurance and your state's policy. Slate reported in March that 37 states have telehealth parity laws ensuring that private insurance companies cover telehealth services [13] the exact way they'd cover in-person services [14]. Through Medicaid, 21 states offer coverage for telehealth services as they would for in-person services, Slate also reported. As for Medicare, telehealth wasn't available for coverage unless seniors on the plan lived in a rural area [15]. Now, under this national emergency, Medicare is waiving that requirement [16] and making it easier to get access to and coverage for telehealth in general.

Some insurances also, according to Dr. Jones, only cover teletherapy if you receive it from a mental health professional with a specific type of licence. She explained they may not cover interns who are practicing under a licenced therapist, or they may not cover the cost of sessions based on the type of therapy provided such as marital counseling. It depends on the underwriting of the policy. It's also important to note that certain insurance companies don't consider sessions via phone to be teletherapy. As ICANotes states [17], "some insurers will cover therapy over the phone, even though Medicare and Medicaid require a video element." Again, due to the current crisis, it's best to check since some providers may have plans in place in response to the novel coronavirus pandemic that offer more flexibility for coverage.

Kayla Murphy, MHC-LP, told POPSUGAR that the New York City and Long Island private practice she works for, Family and Personal Counseling, now offers a sliding scale for clients who can't afford their usual copay due to the pandemic. If a therapist offers payment on a sliding scale, that means you and the therapist work out the cost of the session ahead of time depending on what you can afford. Dr. Jones, who started offering teletherapy in 2017, said she charges her clients the same amount of money for teletherapy as she does for in-person sessions. You should speak with your therapist, or prospective therapist, about rates during this time.

The Rise in Teletherapy

Telehealth visits in general in the US surged by 50 percent this past March [18], according to research from Frost and Sullivan consultants, and an increase of teletherapy sessions seems to be trending as well. Talkspace has seen an increase of about 250 new therapist applicants a day as of late March when POPSUGAR spoke with Amy Cirbus, PhD, LMHC, LPC, director of clinical content at Talkspace. And, since mid-February, Talkspace, which is currently offering a COVID-19 anxiety management program to subscribers, has also seen a major increase in people seeking therapy — user volume is up over 65 percent year-over-year. AbleTo, according to a spokesperson, has seen a 30 percent uptick in engagement and people scheduling appointments compared to the beginning of March. Dr. Jones and Murphy both said that their client numbers have gone up.

Is Teletherapy Beneficial Right Now?

Teletherapy has been shown to be as effective [19] if not more effective [20] than face-to-face therapy in the long run. However, it depends on your personal preference and relationship with your therapist — that's something that the majority of mental health professionals POPSUGAR spoke to for this article stressed.

Nothing beats human contact face to face, Dr. Jones said, but having access to therapists via phone or video during the coronavirus pandemic is particularly convenient and crucial for her clients. "Since we're in a time of crisis, I definitely think that people should reach out and look for therapy online," Dr. Jones noted, adding that we should be putting our mental health needs first.

Reena Pande, MD, chief medical officer at AbleTo, pointed to the fact that with this crisis, "we very much expect there to be an uptick in the levels of anxiety, feelings of social isolation, fear in the context of all the ambiguity and the concerns about people's health." Social isolation and loneliness in particular, she told POPSUGAR, has an impact on our mental health, and this pandemic can cause stressors in many aspects of people's lives, whether that be family dynamics, health and safety, or financial stability. "I think it's a combo of anxiety and fear married to issues that will arise from isolation and loneliness that together will be problematic for so many individuals," she explained. That's why access to teletherapy is so imperative.

"You don't need to be in the same room to feel the empathy that a therapist can give you," Dr. Pande said. "So I think that relationship can be strong no matter what."

Next Steps to Signing Up for Teletherapy

If you're interested, here are some steps you may want to take:

• Read up on the different types of mental health professionals [21].
• If you regularly go to therapy, ask your therapist if they're offering teletherapy and what types they offer.
• If you need to find a therapist, use resources like Psychology Today [22], and make sure that the therapist you're considering is licenced in your state and they have had experience using teletherapy before. (As Monahan said, "You don't want someone learning on you.")
• Consider tele-mental health platforms either individually (Talkspace, for example) or through your health plan (AbleTo, for instance).
• Speak to your health insurance provider on reimbursements and coverage options during this time.
• See if organisations in your community or other services are offering mental health services for free. You'll find some of those options ahead.
• Read up on mental health management tips from trusted resources like the National Alliance on Mental Illness [23] and the National Suicide Prevention Lifeline [24].

Free Mental Health Services During This Time

Many private practices or teletherapy platforms are offering discounts amid the pandemic, but it's also worth checking for free services, whether that be full therapy sessions, messageing with a licenced therapist, or hotlines you can call. Some services are designated to specific states. For instance, New York City has a COVID-19 Emotional Support Hotline manned by mental health professionals at 1-844-863-9314. And startup Real [25] opened early to offer free services through the end of April for those living in New York state. The Real to the People [26] program, in response to this pandemic, includes one-time "digital mental check-ins" and four-session "digital group salons" hosted by licenced therapists on topics such as "Overcoming the Trap of Productivity to Surviving" and "Thriving While Single During Quarantine."

BetterHelp, in partnership with Thoughtful Human, is offering anyone who needs it one month of free messageing, phone, or video sessions [27] with a licenced therapist [28] (free from whenever you sign up). Talkspace is offering a free month of services to a limited number of healthcare workers [29] on the frontlines of the coronavirus pandemic through its Unlimited Messageing Plus plan, which includes text, video, and audio messageing with a licenced therapist. According to a spokesperson, as of now and through donations, Talkspace is able to extend this offer to at least 2,100 healthcare workers. They can sign up through the Talkspace app [30] or website [31] by providing their NPI [32] and state of residence for verification.

Experts we spoke to stressed that, during this time, communicating with a therapist online is still only considered teletherapy if you have ongoing sessions via phone or video. But, they said that services such as hotlines, texting, or audio messageing can still provide therapeutic benefits amid this pandemic. It's up to you and what you're comfortable with. No matter which avenue you choose, be sure to take care of your wellbeing.