• Nicole L. Bickham

I’ve been offering sessions exclusively via telehealth for nine months now, and during this time, there are a few things I’ve observed that seem to result in a better experience for both me and my client:

  1. Both of us wearing headphones. By now my clients are quite used to seeing me don my headset. It allows me to hear and be heard more clearly, reduces background noise, increases privacy, and reduces feedback from the computer speakers. I have observed that sound quality is better when the client wears earbuds or a headset (whether for video or phone sessions) as well, for all of these reasons. Even a simple, $10-15 pair of corded earbuds from the drugstore is usually an improvement. (Noise cancellation is not a necessary feature for our purposes.)

  2. Closing background applications. Any applications running in the background will slow down the video connection. Email is one of the major culprits. Having other devices on the same internet connection also makes a big difference. Of course sometimes this can’t be avoided, but if you have a phone or other device not in use, temporarily turning off its use of WiFi could help.

  3. Using video at least once in a while. Sometimes video sessions are impossible because one’s internet connection just can’t support it. I also have clients who prefer phone sessions because they don’t have privacy at home but can take a phone call somewhere else. Some clients say they just have more ease when they can’t be seen. Some like to have sessions while walking outside. I have been surprised at how well phone sessions work, and most insurance companies have loosened (temporarily) their restrictions on telehealth by permitting phone sessions. However, I have noticed that when my phone-based clients can occasionally arrange for a video session, our work seems to land more deeply. This makes sense, because humans are relational beings who evolved to use visual cues, especially the faces of others, to make sense of our environment. If you have been using phone exclusively, here are some considerations for an occasional video session: (a) Simple Practice, the HIPAA secure system I use, offers a free phone app that works quite well as long as you have sufficient bandwidth (whether via WiFi or cellular data); (b) a white noise machine (or device running a white noise app) placed just outside the room in which you will have a session can do wonders to enhance privacy; (c) if you prefer not to be on camera, or if bandwidth is an issue, we can connect using video, but turn our cameras off most of the time; having the option to turn the camera on, even if just for a few moments during or at the end of a session, can be helpful.

You may have noticed a new address (Oakland Ave) showing up on your appointment reminders and billing statements. This is the mailing address I will be using for the duration of the COVID crisis. When it is safe to return to in-person sessions, I intend to return to both my Glendale and De Pere locations, though telehealth will likely be an ongoing component of my practice.

I continue to track insurance coverage for telehealth. Most of the insurance companies with which I work, as of now, have extended their telehealth coverage through Sept 30th, while a few have said they will cover telehealth through the end of the year. All of these policies can and likely will be renewed. It is difficult to predict how things will unfold as we approach the end of 2020, but I am optimistic that telehealth will continue to be covered for the duration of the crisis.

I recommend closely reading any correspondence you receive from your insurance company. If you have any questions about your coverage, please let me know, and we can discuss options for getting clarification. If there comes a point when your insurance company is no longer covering telehealth across the board, we may still be able to get permission for telehealth sessions by speaking with your insurance plan.

  • Nicole L. Bickham

With the Safer at Home order no longer in place in Wisconsin and many businesses re-opening, you may be wondering when we will be able to meet in person again. I have certainly been thinking about (and feeling into) this a lot since the pandemic began! The information I'm sharing here is not meant to be a substitute for the conversations we will all be having about when we will meet in person again, but I thought you might find it useful to hear what I am taking into account.

I have been closely following the accumulating scientific understanding of the virus, and paying close attention to the opinions of public health experts where the data do not yet exist. I am also considering a number of practicalities, including the size of my offices, the nature of shared spaces in the buildings (reception areas, restrooms, etc) relative to best practices for physical distancing, my capacity to insure these spaces are sanitized properly, ventilation, the amount of time I would need to spend at the office in order to space out sessions appropriately, and how therapy would be affected by wearing masks, as is currently recommended. Finally, but most importantly, I am considering the relative risks, to my clients and family members, of continuing to conduct telehealth sessions versus meeting in person.

My current conclusion, after considering all of these factors, is that I will NOT be offering in-office sessions any time soon. And that's as specific as I can be, for now.

I understand the ambiguity about the timeline may be frustrating. Some of you have been expressing a wish to return to office visits for weeks, so I imagine this news may be disappointing, maybe even confusing, as you see things gradually starting to look "normal" in our communities. (If so, let's talk about it at our next session!) Others of you have expressed your concern about the risks of meeting in person, so perhaps you feel reassured by my take on the issue.

It's undeniable that meeting via screens is not the same as meeting in person, and some aspects of the therapeutic connection just can't be replicated via telehealth. That said, the overwhelming majority of my clients have expressed satisfaction with telehealth sessions, and I myself have been surprised at how well the process has translated. Your preferences matter to me, AND there is much more to consider; this pandemic is giving us many opportunities to practice acceptance of "what is."

If the idea of sticking with telehealth sessions indefinitely doesn't feel right for you, let's talk about it. I want you to have the most supportive experience possible, so let's discuss options.


If you use insurance to pay for sessions, you may be wondering how long telehealth sessions will be covered by your plan. This is difficult to answer, because every insurance payer has its own policies. Some already allowed reimbursement of telehealth services prior to the COVID-19 crisis, while others made temporary allowances for telehealth shortly after the pandemic started. These temporary changes expire at different times, and may be extended; some changes have been or may later be made permanent, as is being advocated by the American Psychological Association and other health advocacy groups. I am tracking all of this as closely as I can, and I encourage you to stay abreast of any notices your insurance company provides. That said, it is possible that some changes will be made with little notice. We will do our best to navigate that together.

Ultimately, the value I place on safety (yours and mine) and my ethical duty to uphold that value takes precedence over my need to be paid by insurance companies. We can negotiate out of pocket fees (or look at referral options, if you wish) if your insurance company stops paying for telehealth sessions and I am not yet ready to return to the office. Please bring this up when we meet next if you have any questions or requests.