Working harder in anxious times, mental health providers getting paid less for safer service

Jill Lehmann-Bauer counsels veterans, teachers, government employees and others who have a mix of mental health issues ranging from post-traumatic stress to anxiety to major depression.

Typically, the therapist sees clients in her Clive office at Central Iowa Therapy Solutions. But some have COPD and other chronic lung disorders that make them more susceptible to coronavirus infection, so this week she began doing psychotherapy online to help lessen the spread of COVID-19.

From her first session Monday, however, Lehmann-Bauer heard mixed messages about whether insurers would cover such telehealth mental health services.

“My first client said she called Wellmark (Blue Cross Blue Shield) and got two answers,” she told Watchdog. “I did the session for free.”

► More:The latest on coronavirus in Iowa

Even for those without a diagnosed mental illness, the COVID-19 pandemic has triggered much greater stress over family, work and financial well-being. For those with anxiety and depression, the two most common mental illnesses, the increased isolation required could exacerbate their conditions, experts say.

“One thing that seeds anxiety and depression is isolation, and we’re being told that’s what you need to do,” said Peggy Huppert, executive director of the National Alliance on Mental Illness in Iowa. “The longer this goes on, the more ramifications we’re going to see.”

For the one in five Iowans who experience a mental illness in a given year, lack of access to mental health care has been a major problem, especially in rural Iowa, Huppert said. Telehealth offers a solution, but state leaders have yet to require mental health parity to make that happen.

“We have a problem with telehealth reimbursing (providers) at the same level. All sorts of barriers are being thrown up by insurance companies,” Huppert said.

In some places in Iowa, Iowans with serious mental health issues have no access to onsite mental health professionals. The state has just 300 psychiatrists and only 30 for children. 

► More:

• Gov. Kim Reynolds prohibits gatherings of more than 10 people, limits restaurants, closes theaters, casinos, bars
• What's been closed, canceled or postponed around Iowa as a result of the spreading coronavirus
• Health director: If you have mild coronavirus symptoms, call 211 instead of going to the doctor
• How to prepare, what to expect, what will be affected by coronavirus in Iowa

In states like Ohio and Massachusetts, governors this week announced emergency orders lifting barriers to telehealth services, including telephone and video chat opportunities, so mental health professionals can help those struggling during the pandemic.

Such services are being covered and fully reimbursed to providers under Iowa's privatized Medicaid insurance, according to Iowa's Department of Human Services. 

But providers like Lehmann-Bauer learned this week that Wellmark, a top insurer based in Des Moines, will cover only 75% of the in-office rate for telehealth sessions.

The lower rate, she said, means a significant pay cut for the clinical social workers, marriage and family therapists, psychiatrists and psychologists on the front lines of the crisis.

For Lehmann-Bauer, the lower reimbursement rate amounts to a loss in income of about $3,600 a month.

“Would they pay a doctor less in the face of a pandemic? Or is this something related to the value of mental health care?” she asked. 

She and other providers on Tuesday appealed to Gov. Kim Reynolds and state leaders to require insurers to reimburse mental health providers fully for telehealth services so they don’t risk going under as they attempt to help people during the pandemic.

The demand is high, Lehmann-Bauer said.

“I didn’t even have time to eat yesterday,” she said. “Was my work worth 25% less?”

On Tuesday, Wellmark announced that all those insured by the company would receive full coverage, waiving any co-pays or other cost-shares, for virtual visits, both for medical and behavioral health, for 90 days. 

The insurer said the decision would be reassessed at the end of that period. 

"While Wellmark’s preference is that providers conduct telehealth visits via interactive audio-visual technology, we recognize that some of our members may not have a smartphone, tablet, or personal computer capable of engaging in an interactive audio-video visit," the insurer announced. "As such, Wellmark will allow telephonic visits during this 90-day period, when audio-visual capabilities aren’t accessible."

The company said nothing in its announcement about fully reimbursing providers.

Lehmann-Bauer said providers who do online or phone sessions help insurers save money by holding down the infection rate of the pandemic.

“Reynolds has the ability right now to say to Wellmark and other insurance companies, 'You need to cover telehealth' and she’s not doing it," she said. "The governor needs to respond.”

Pat Garrett, a spokesperson for Reynolds, did not respond to requests for comment Monday and Tuesday. Nor did Wellmark spokeswoman Traci McBee.

A bill before the Legislature this year, House File 2192, would provide parity for mental telehealth services beginning in 2021, but that legislation wouldn’t help during the current crisis, Lehmann-Bauer said.

She said she worries most about clients who will become too isolated during the crisis and who have few others to talk to. 

"They're the ones suffering in silence. I’m likely the only one they will come in contact with this week," she said.  

Dani Ausen, a 37-year-old artist, graphic designer and entrepreneur living in Des Moines, said she had a telesession with Lehmann-Bauer on Monday to work through the stress she's feeling for herself and others whose livelihoods are at risk because of the pandemic.

"I realized just how anxious and afraid I am," said Ausen, who has anxiety. 

Still, she said, others need that therapy far more than she does. 

"This being an unbelievably stressful moment in the country, taking away that important mental health care is not going to be helpful," she said.

Anxious or depressed over the pandemic?

The National Alliance on Mental Illness HelpLine is available Monday-Friday, 9 a.m. to 5 p.m. at (800) 950-6264.

Here are some tips to cope. For more, go to NAMI's guide in dealing with the pandemic:

• Remember that knowledge is power. Understanding the factors that affect a person’s immune response to COVID-19 will matter as much as, or more than, understanding the virus. People with poor lung health caused by smoking, lack of adequate health care, suppressed immune systems, and those who are particularly susceptible to infectious diseases, such as the elderly, have been particularly affected by COVID-19.
• Don’t accept everything you read or hear. Look beyond rhetoric and arm yourself with information. The U.S. Centers for Disease Control and Prevention provides information and frequent updates. To subscribe to the CDC’s email and text message service, visit CDC Subscription Service.
• Get your emotional support system in place. Maintain familiar routines as much as possible; take care of your basic needs and employ helpful coping strategies: rest during work or between shifts; eat healthy foods and engage in physical activity; and stay connected with others and maintain your social networks.
• Take control and incorporate preventive measures: Wash your hands. Avoid watching, reading or listening to news reports that cause you to feel anxious or distressed. Instead, seek CDC updates and practical guidelines. Be supportive to others. Assisting others in their time of need can benefit the person receiving support as well as the helper.

Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Reach her at lrood@dmreg.com or 515-284-8549. Follow her on Twitter at @leerood and on Facebook at Facebook.com/readerswatchdog. Our subscribers make the Reader's Watchdog possible.

Subscribe today at DesMoinesRegister.com/Deal to support her work.