» As patients drop sessions, therapists’ anxiety grows.
Mental health professionals seeing clients online, but that might not be enough for some to make ends meet
Tricia Miller usually sees 10 to 14 clients a week at her practice in Memorial, helping adolescent and adult patients work through anxiety and other mental health issues.
But since the coronavirus outbreak shuttered schools and prompted thousands of layoffs, the licensed professional counselor said visits have been cut in half as clients postpone and cancel appointments.
Now she sees just five or six clients a week over video conferencing technology.
“I’ve accepted I’m going to take a cut,” Miller said.
While hospitals and physicians brace themselves for a surge of patients contracting COVID-19, the disease caused by the novel coronavirus, not all health care providers are seeing brisk business. Houston’s therapists are increasingly worried that clients will drop out of therapy while improvising solutions to keep their businesses afloat and pay the bills.
While most therapists have switched to video sessions and other telehealth technologies, that hasn’t been enough for some to keep their clients.
In a survey of 96 Houston therapists by Mental Health Match, a startup that pairs people seeking therapy with qualified counselors and therapists in Greater Houston, nearly four in 10 said one-fifth or more of their clients had
postponed or canceled appointments.
Nirmeen Valiani, a licensed professional counselor in Montrose, sees about a dozen patients a week. As with Miller, about half of her clients have stopped their sessions. In the coming weeks, she could see as few as two clients a week.
Many patients have lost jobs or had their hours cut, and can’t afford to attend therapy regularly.
“Everyone’s in survival mode and needs to get their basic needs met,” Valiani said. “People can’t take care of their mental health because they can’t even go to work.”
Others just can’t do teletherapy, bogged down by technical difficulties or an inability to find a private space in homes filled with kids home from school and parents home from work. The few who have stayed are helping therapists pay some bills.
“I feel very fortunate my clients are still seeing me,” Miller said. “But you see your bank account, and you’re always running the numbers in your mind.”
The insurance dilemma
Many therapists don’t accept insurance. The process to file a claim and get paid takes longer than it would to bill a client directly, Valiani said.
Only 37 percent of the therapists surveyed by Mental Health Match take insurance.
What’s covered at a therapist’s office can vary even within an insurer’s policies. Some policies only pay for a limited number of sessions a year, while others only cover the sessions if clients are diagnosed by doctors.
But even therapists who accept insurance worry if insurers will cover virtual visits.
Michael Devoll, a licensed professional counselor with an office in Rice Military, sees a mix of patients out-of-pocket and on insurance. Each insurance policy varies, and some patients are being told their policies don’t include telehealth visits.
“I don’t know yet if I’m going to get paid,” Devoll said.
The Texas Department of Insurance issued an emergency rule last month ordering state-regulated insurers to pay for telehealth visits, including mental health providers.
Making adjustments
To try to keep patients, some are trying to offer lower fees and new ways to get therapy.
Allison Marek, a licensed clinical social worker in Houston, has offered sliding-scale fees and a “pay what you can” support group during the pandemic. The week before Harris County announced its stay-at-home order, she already had rescheduled all of her appointments onto an online platform.
“I’ve offered to clients to pay me later,” Marek said.
Others are pitching donationbased mindfulness webinars and stress management workshops as a way to cover costs.
Paying the rent
The future is still unclear for many counselors. About 60 percent of therapists surveyed by Mental Health Match expect the number of cancellations to grow.
Miller and Valiani have asked their landlords for flexibility on rent — either deferred or partial payments — in the coming months, worried that they won’t have steady incomes.
They’ve considered applying for small business loans to get through the pandemic, but they would rather find clients to maintain sustainable practices.
The dilemma they face is how far can they go in offering discounted or free sessions as more people deal with heightened anxiety and stress because of the COVID-19 crisis.
“Should I be there for the people who don’t have insurance or who can’t afford it?” Valiani said. “Because I won’t be able to make my rent amount.”