The benefits of Telepsychiatry

[blandy]

Hey all,
 

Has anyone here availed themselves of the services of telepsychiatry? It's really exploding, prompted by a turnaround by the American Psychiatric Association ( who now fully support it). Insurance companies have been slow to come around, but that is beginning to change. The APA reversal triggered most states (38, and counting)  to allow insurance reimbursement for telemedicine/telepsychiatry . My wife has been using a telepsychologist for about 3 years now and greatly prefers it to having to take a ride into the office. I believe that my wife is similar to others in that she is more likely to keep her appointments, given that she doesn't have to dress up and take a car trip order to attend them. And the service is INVALUABLE for those who are severely depressed or agoraphobic and find it very difficult to appear anywhere in person.

Are all telephychiatry programs created equal? Not in my experience. If you are considering it, try ascertaining a few things in advance. (For obvious reasons, it would be better to find the answers to these questions anonymously, if possible). What level of education will your counselor have? (In some states, it can be as little as a bachelors degree). What session frequency would the counselors schedule usually allow for? Do they accept any medical insurance on assignment? What is their fee for those without insurance? (The going rate is about $50 per appointment). Do they script for medication without a client coming in for a visit in person? Do they script for controlled meds, if they find them to be necessary, in the same manner? Then check with your own insurance company to see if you are covered.

(This is a booming field and the competition is fierce, as different practices compete for new business. This just might lead some of them to be a little more likely to go to the prescription pad. I think that is what happened in the case of my wife. They want to keep her as a client. They are an up and coming practice and need teleclients badly).

Let me tell you about my wife's experience. Her counselor is a psychiatric nurse-practitioner. She has never seen her in person. She talks to my wife using "Facetime" through her phone. She wrote for an AD on the first "visit". Wrote for ALP on the second visit. (.50 x45 w. 3 refills without ever having seen her). Wrote for a different AD on the third visit. She eventually found the right AD for her and her counselor has been providing scripts for that straight through. Same thing with the ALP! She constantly asks my wife if she needs more. My wife leads a charmed life. Where do you ever find a medical person who tries to push a benzo on you? Anyhow, all that to say that it has been a great experience. An important thing to note is that she never had to appear at the office, pick up a script for the ALP and bring it to the pharmacy. It was sent electronically to the pharmacy by a practitioner whom he has never met in person. Can't beat it.

Would love to hear from anyone who used telepsychiatry, is thinking of using it, or anyone else who feels like commenting. Thanks

This must be a a great thing for people with issues with initial meetings or agrophobic's.
I had never heard of it till now. Social anxiety and meeting new people don't mix and I would have started a lot earlier if i knew this was available.
Thanks for the info i'll be sure to recommend It to people who are in this type of situation.

I do however think it should Just be a period of initial introduction to gain trust with the Psychotherapist for me you can't beat talking therapy face to face.

[happyvibe]

I think its great for people to have that option. I know personally I've needed the face to face interaction with someone in order to gain their trust.

[Rafterman]

I think its great for people to have that option. I know personally I've needed the face to face interaction with someone in order to gain their trust.

Totally agree, Happyvibe, and can relate. I usually feel tense when seeing a new doc and once that face to face rapport is established (sometimes within the first few minutes) I can feel those worries melt away. I like the option of doing this from my house. I have some residual GAD and although I haven't had a PA is years, the "what if's" live on. That makes it more difficult than it may seem to sit in a waiting room, then in an exam cubicle, make conversation with the nurses, etc. But once the ice is broken, the rest goes smoothly. An tele-consultation can help me skip by the bad parts and get right to the face-to-face. I hope that it continues to rise in popularity. RM

[Rafterman]

Cornerstone Health, one of North Carolina's largest health care providers, announced yesterday it's push toward telemedicine. All specialties will be available, including psychiatric. Of course, in-office visits will still be available. This shift is being seen all over the country as providers seek to save money and time, while providing convenience to their patients. While a tele-visit will never be able to provide the level of care that an in-office visit can, the methods used are becoming more sophisticated. For instance, attachments for smartphones to let them take and send real-time readings of the patients blood pressure, heart rate and rhythm, and an actual live EKG. As we have been discussing on this thread, many patients who avoid doctor visits due to anxiety and depression issues may be more likely to attend a tele-visit. These visits are covered by Medicare and most private insurance. Doctors are permitted to prescribe medication, and  order imaging tests and therepy during a tele-visit. I am excited that this modality is expanding in my state. While it's not for everybody, it can potentially help countless people who are hesitant to attend a conventional doctor visit. Has anyone seen telemedicine expanding in their own state?

[MoJim]

Great thread Rafterman. My only experience with tele doctors was with MMJ. I had to go to the clinic and was put in a room where I talked to the Dr. on the tv and then got my card. It never occurred to me that it was possible to get scripts for bezo's in a similar manner. I currently make a two hour round trip to see my regular Psy. Even if insurance didn't pay, it might be worth it.

[Naomi]

Does anyone know how to get started with this? I'm interested, but from Google searching I'm not getting an exact answer on reputable companies that provide this service. Has any one done this? Did your insurance cover it? I'd really like to switch over to it, but I haven't found a ton of reviews.

[Rafterman]

Great thread Rafterman. My only experience with tele doctors was with MMJ. I had to go to the clinic and was put in a room where I talked to the Dr. on the tv and then got my card. It never occurred to me that it was possible to get scripts for bezo's in a similar manner. I currently make a two hour round trip to see my regular Psy. Even if insurance didn't pay, it might be worth it.

Thanks, MoJim
Wow, a two hour round trip. Maybe you should ask her if she would do tele-visits with you, after you see how your insurance company feels about it. My wife was making a similar length trip to see her Psy and then she started on tele-psy about 8 months ago. They use a program called "Facetime", but Skype is also available. Sometimes, they skip the visual and just do a phone visit. The insurance is totally cool with it. In fact, now that have begun to encourage it. And her Psy continually writes for ALP and two AD's for her. My wife never even sees the scripts. They are sent by computer to the local pharmacy. We first looked into this about 5 years ago and only about half of insurance companies were covering it then. Now, I believe that number is around 80%. There is such a rush by different healthcare companies to set up tele-health programs that many are offering visits for as low as $35 (the typical price is $49, all over). That may even go lower as the competition heats up. And it is my own personal opinion that docs giving tele-visits might be slightly more prone to write for benzo's and other popular meds as the look to lock down their share of this new market. They all want to secire new customers to help make their start-up's a success. I hope that you will be able to move over to that because I think that you will really like it.  Cheers. RM

[Naomi]

I just checked into virtual visits that my insurance covers and it seems like they cover most everything except they won't prescribe benzos, so there goes that option. I wish my current in person psychiatrist would just Skype with me.

[Rafterman]

I just checked into virtual visits that my insurance covers and it seems like they cover most everything except they won't prescribe benzos, so there goes that option. I wish my current in person psychiatrist would just Skype with me.

Hey Naomi. Are you saying that the insurance company is the problem because they refuse to cover any tele-medicine provider that prescribes benzo's, or that you are having trouble finding a tele provider who will prescribe them? If its the latter, don't give up. Places that still won't prescribe benzo's are going to find themselves being in the minority very soon. I think that you may have access to several different places that are doing tele-medicine because almost every hospital is now set up for it and local docs are jumping on the bandwagon, one by one. My primary, who runs a very old fashioned practice, just came on board. The federal government is actually pushing it right now. It's requesting that all practices that are operating as ACO's (a form of managed care) make tele-medicine available to their patients. And if it is the insurance company that is the problem, remember that some of the tele places are only charging $35 per visit and will prescribe benzo's. There is the option to pay that out of pocket and forget the insurance company. It may be worth it if you can snag a script for benzo's out of the appointment. I know that it tricky to find out if a tele practice will script for benzo's. You don't want to show what they might see as "drug seeking behavior". Word of mouth is better, but it takes a lot of asking around to people you know, particularly if they work in the medical field. Let me know how you end up doing with this. Thanks.  RM

[Naomi]

Yeah, I checked the two options my insurance offer, and both companies say no benzos which is my main need. I just wish I could find a reputable online company with legit reviews or if my psychiatrist would agree to Skype and I'd pay out of pocket.