Will My Insurance Cover Virtual PHP?
For any parent, navigating the mental health care system and finding care for your kid can be tough. Figuring out whether, and how much, your insurance will pay for treatment can be even tougher.
For relatively specialized, intensive levels of care like partial hospitalization programs (PHPs) or intensive outpatient programs (IOPs) it can be even harder. On top of that, virtual care is still relatively new.
The Big Picture
Nationally, five years on from telehealth exploding at the start of the pandemic, the picture remains uncertain. The House has just voted to extend telehealth flexibilities until September 2025. This doesn’t directly affect care for most kids, but sets the tone for Medicaid and commercial insurances. Also, new rules on mental health parity that came out at the end of 2024 mean it’s harder for commercial insurances to impose limitations on treatment for mental health that do not exist for physical health care.
So Will My Insurance Pay for Bradley REACH?
The good news is that, in New England, most commercial insurances will cover virtual PHP and are pretty familiar with this level of care. In Rhode Island, the Office of the Health Insurance Commissioner (OHIC) has worked to support telehealth as a way of expanding access to care. As part of this drive, all behavioral health services delivered via telehealth should be reimbursed at the same rate as they are in-person. Rhode Island Medicaid for children and families (RIte Care) also reimburses for virtual PHP and IOP.
In our Florida program, we have contracts with several major commercial insurances, and also have funding in place to support uninsured or underinsured children to participate in the program. When we open new programs, we work closely with partners to get insurance contracts in place to ensure that we have as much coverage as possible.
Provider licensure compacts mean that’s now easier than ever to treat kids across a range of states, even where we don’t have an established presence. We are so excited to expand access to this level of care for families who are struggling. We’re able to work with most Blue Cross Blue Shield plans, and often with other large commercial insurers where we have some existing contracts. If you’re not sure or have questions, we’d love to hear from you - please get in touch on bradleyreach@brownhealth.org.
What Can I Do If My Insurance Doesn’t Cover Virtual PHP?
Even if your insurance doesn’t have a contract to cover virtual PHP programs like Bradley REACH, we can still work with your insurance provider to get a single case agreement in place, where your insurance agrees to cover a needed service on a one-off basis. Getting single case agreements can be an important part of flagging the need for new services and levels of care to insurers, so we’re always happy to help with this.
PHP and IOP are vital parts of the continuum of care in mental health. Inpatient stays are often needed, but also short, and sometimes don’t give teens and their families the time and space to address underlying issues. Outpatient care is vital, but often not enough for teens who are really struggling or leaving higher levels of care and looking for more support. Providing these services virtually makes them available to teens and families who couldn’t access this level of care otherwise.
As a parent, you can play a vital role in advocating with insurance companies and policy makers to build the case that reimbursing sustainably for this type of care can play an important role in addressing the crisis in adolescent mental health.
Get Mental Health Care
We’d love to connect you or someone you know with mental health care. To refer a child/teen/adolescent or yourself, please call (877) 992-2422 or click here to make a referral. Bradley REACH’s expert teams of psychologists, psychiatrists, social workers, and nurses provide intensive mental health care and therapy to teams and families, virtually, in New England, Massachusetts, Connecticut, New Hampshire, Rhode Island and Florida.
DISCLAIMER:
The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment.
If you or your child are in crisis or experiencing mental health problems please seek the advice of a licensed clinician or call 988 or Kids Link in Rhode Island.
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