Online Therapy or Teletherapy Denied by Insurance? What to Do

Teletherapy — therapy conducted by video, phone, or other remote means — expanded dramatically during the COVID-19 pandemic, and federal and state laws now require many insurers to cover it on the same basis as in-person care. Yet denials continue, based on outdated exclusions, platform restrictions, and location requirements. If your online therapy claim was denied, here's what to know.

The Legal Landscape for Telehealth Coverage

Federal law. During the COVID-19 public health emergency, federal agencies relaxed telehealth restrictions significantly. Many of these flexibilities have been made permanent or extended through legislation:

• Medicare permanently covers many mental health telehealth services without geographic restriction
• The No Surprises Act includes telehealth coverage provisions
• The Consolidated Appropriations Acts have repeatedly extended telehealth flexibilities

State parity laws. As of 2026, the majority of states have enacted telehealth parity laws requiring that:

• Covered health benefits provided via telehealth are reimbursed at the same rate as in-person services
• Insurers cannot deny coverage solely because the service was delivered via telehealth

Check your state's specific telehealth parity law — the coverage obligations vary in scope and applicability.

Employer plans. ERISA plans (most employer-sponsored plans) are federally regulated and may not be subject to state telehealth parity laws. However, many large employers have adopted telehealth coverage policies that provide parity.

Common Reasons Teletherapy Claims Are Denied

"Telehealth not covered" / plan exclusion. Older plan documents may still contain blanket telehealth exclusions. If your plan was written before state telehealth laws took effect, check whether the law applies retroactively or prospectively.

Location requirement. Some plans require that the patient be located in a rural or underserved area to receive telehealth. Many state parity laws have eliminated this geographic restriction. Check your state.

"Must be an established patient." Some plans or providers interpret coverage requirements to apply only to established patients. This is increasingly rare but still exists.

Audio-only calls denied when video required. Some plans specify that telehealth services must be delivered via two-way video, not phone only. If your therapist conducted sessions by phone, check your plan's telehealth technology requirements.

Third-party platform denial. If you used a consumer telehealth platform (BetterHelp, Talkspace) rather than a licensed therapist billing through your insurance, coverage is different. These platforms bill insurance separately, and coverage depends on whether the platform and therapist are in-network with your plan. Claims from out-of-network telehealth platforms may be denied or reimbursed at out-of-network rates.

Therapist not licensed in your state. Insurance coverage generally requires that the therapist hold a license in the state where the patient is located. If you had a session with an out-of-state therapist, coverage may be denied.

Building Your Teletherapy Appeal

For state parity law violations:

1. Identify your state's telehealth parity statute
2. Confirm your plan is subject to state law (fully-insured plans are; ERISA plans may not be)
3. Document that the only basis for denial was the telehealth modality
4. Cite the specific statute in your appeal: "Pursuant to [state code], insurers are required to cover telehealth services on the same basis as in-person services."

For outdated exclusion language:

• Compare the denial language to your state's current telehealth parity law
• If the exclusion predates the law, it may be unenforceable

For location restriction denials:

• If your state has eliminated geographic restrictions for telehealth coverage, cite the statute
• Document your location at time of service

For audio-only coverage:

• Check your plan's telehealth definition carefully
• Many state laws specifically require coverage for audio-only telehealth for mental health services
• If your state mandates audio-only coverage, cite the law

Third-Party Platform Claims (BetterHelp, Talkspace, etc.)

Consumer mental health platforms are not traditional insurance billing. When you use these platforms:

• Some platforms have their own insurance billing arrangements and are in-network with select plans
• Others provide superbills that you submit to your insurer for out-of-network reimbursement
• If you're using a platform that doesn't accept your insurance, you're typically paying out of pocket

Check whether your plan covers out-of-network mental health services, what the reimbursement rate is, and whether the platform therapist holds a license in your state.

Fight Back With ClaimBack

If your teletherapy was denied despite state parity protections or based on an outdated plan exclusion, ClaimBack helps you identify the applicable law, draft your appeal, and file your complaint.

Start your teletherapy denial appeal at ClaimBack

Related Reading

• What Is Medical Necessity?
• How to Write an Insurance Appeal Letter
• Mental Health Parity Violations