Six Counselor Rumors About Accepting Health Insurance
Anthony Centore
From recent graduates to seasoned clinicians, today it seems that everyone in part- or full-time private practice is asking the same question: “Should I accept health insurance?”It’s a complicated question. The decision whether to accept third party payments will have a big impact on your counseling practice. The question is made even more difficult as there isn’t just a lot of information to consider—there is also a lot of misinformation about working with insurance companies.
Below are a few semi-misguided statements I’ve heard from counselors worried about accepting insurance. I’ve tried to provide a helpful response to each statement:
1) “I’ve heard I should stay away from accepting insurance.”
In the same way that your parents might have told you “don’t do drugs,” some counselor’s mentors have warned them “don’t do insurance.” The idea of starting a cash-only practice is enticing! There’s less fuss with billing, and you can set your own prices for services. The downside is that building a private practice, even with insurance, is hard work—starting a “cash-only” private practice can be even harder. While some clinicians succeed, many counselors struggle to maintain a large enough cash-paying client base to make a living. This may be okay if a counselor wants only a part-time practice, or has a separate source of income.
2) “I’ve heard that insurance companies don’t pay well.”
There are a few companies that pay particularly poorly. However, the idea that insurance companies don’t pay well might be overstated. In Boston, the average intake appointment (90801) pays about $100 for a clinician with a Master’s degree. Ongoing appointments for individual therapy (90806) pay around $75-87, and appointments for couples counseling (i.e., “family therapy with patient present”, 90847) pay about $10 more.Note: these are 45-minute sessions, not 1-hour sessions.If a counselor can fill their client roster with clients who are willing to pay these rates (or higher) in cash, great! For them, accepting insurance probably doesn’t make sense. On the other hand, insurance might be a good option if there are gaps in one’s schedule, or if one’s sliding scale keeps dipping significantly lower than what insurance would otherwise pay.
3) “I’ve heard that insurance companies are impossible to deal with.”
Not exactly. When it’s business as usual, insurance companies are easy to deal with (you submit claims, and receive payment). However, at times when there is confusion over an unpaid claim, insurance can be a hassle. Calling may amount to some hold time, and perhaps a few frustrating exchanges with the “provider relations department.”Still, working with insurance is not impossible. If you don’t want to interact with them personally, you could consider hiring a billing company. The cost is usually about 8% of what they collect. Since this doesn’t include client co-pays and deductibles (cash you’ll receive from clients), it ends up somewhere around 5.5% of your gross revenue.
4) “I don’t want to be a ‘slave to’/’employee of’ insurance companies.”
Being networked with insurance companies, you are neither a slave, nor an employee. You are simply affiliated (i.e., credentialed), which means that you have been given approval to bill insurance for authorized services that you render to their insured customers. Where some providers find frustration is that insurance companies are not willing to authorize care to patients with certain diagnoses, such as “V codes” (e.g., relationship problem, academic problem, etc.). Hence, to receive payment for services, some counselors find themselves trying to justify a biological diagnosis, such as Major Depressive Disorder, even if the patient’s presenting symptoms fall short of the diagnostic criteria.
5) “I don’t want to do all the additional documentation.”
Don’t confuse a private practice that accepts insurance, with a more bureaucratic setting such as a hospital, or a government-run medical clinic. As a licensed counselor, you are already taking clinical notes—at least a diagnostic evaluation, treatment plan, and SOAP notes each session (right?). That’s all you need.
In fact, insurance companies aren’t generally going to ask to see this, and they can’t dictate to you how you should do your record keeping. What insurance companies will ask for are dates of service, patient diagnoses, and procedure codes.
6) “I don’t want to be told what clients I have to see.”
This is a common misconception. Even if you are networked with an insurance company, you are never required to see any particular patient or client. You still get to decide what clients you want to see, and what clients you would rather refer.
Dispelling Rumors about Insurance, Not Advocating for It.
In the above paragraphs, we reviewed 6 common rumors about accepting insurance. However, I’m not advocating that insurance is the right fit for you and your practice. Such a decision requires a much longer consideration, outside the scope of this short article!
Anthony Centore is a counselor, and helps other counselors build successful practices. For more information on private practice and insurance panels go to http://thriveworks.com .
In Massachusetts, one big provider pays clinicians $ 60.00 for a diagnostic and just ” $50.00″ for an individual session. Another provider pays the standard rate of $ 59.71 whether or not you bill for an individual or for a couples/family sessions as well. The social work and mental health associations in my state refuse to ask for more money because of the fear of rocking the boat. I agree it is important to have a bookkeeper to do your billing for you. I use an excellent biller who does a fabulous job in making sure my billing is accurate for several insurance companies.
Hi Robin! Thanks for your comment. Some insurance companies sure do pay poorly (we have found that BCBS, Aetna, UBH, HP, and Tufts bay better). These rates that you’re quoting, does that include or not include the patient’s copy?
Hi Robin! Thanks for your comment. Some insurance companies sure do pay poorly–I’m curious to know what companies you are working with (we have found that BCBS, Aetna, UBH, HP, and Tufts pay better). These rates that you’re quoting, do they include or not include the patient’s co-pay?
Anthony – thanks for the article. I’m in the middle of the same debate. My practice is starting well but I’m finding that I tend to collect on the lower side of my “sliding scale” fee. I’m ok with this but if I’m going to charge the lower end of my sliding scale, I should seriously consider accepting insurances whichl approach my rates.
I have a question. I have a LPC in PA and have a few clinicians working for me. They are both masters level therapists who are in the process of licensure. Right now they are private pay clinicians. Since I’m supervising their cases, is it legal/ethical for me to have their clients submit to their insurances? Logically it seems that insurances wouldn’t pay for anyone besides myself but I’ve been told otherwise and would like some feedback.
Thanks for your time. I enjoy the articles.
Anthony re #5 I just received notice that Lifesynch will be auditing 50% of my charts. I would really like some info from someone who has been through this, with any company. Their record keeping criteria is much more controlling than other companies.
I was guilty of not reading my contract cover. You might want to add this to your article.
Thank you in advance for any support you can provide.
FYI – Just a note regarding diagnosis and impact on clietns. Be careful how you diagnose your clients for billing purposes beyond just the ethical implications. Did you know that some life, long term care, and disability insurance providers are now turning down applicants for certain mental health diagnoses in their medical history such as major depressive disorders and other mood disorders? Just something to keep in mind. Sad to say that some clients may be penalized for getting better mental health.
Generally speaking, I would have to say that insurance companies are fairly difficult to work with vs self-paying clients. They typically determine the amount they can pay you (not the price you set) and some of them take months to reiumburse you after a claim is made.
While I do understand that not everyone can only work with self-pay clients, I would say that #1-3 & #5 is mostly true and not just a “rumor” but a common experience of many clinicians.
I am noticing how much different rates are in different parts of the country. I am writing this a year after the article was published, and wanted to note that my rates as a provider have been decreased at least twice in the last 2-3 years and I am making less per session than 4 years ago when I had all cash clients. Insurance in the Arizona area is paying between $42-65 per session, with $55 being the average. Intakes seem to range between $84-99.
I use a mental health billing service and find that they are able to get the insurance to pay on all claims except where the client does not have those benefits. It may take awhile, but they do collect.
Conversely, my rent is significantly higher than stated in the article.
I agree with most of the comments above. I have to say that the reimbursement rate in Kentucky is way lower than what Anthony has indicated. Our reimbursement is between $30 (Compsych) to $75, with most of them falling below $60. It is sad to think that I get paid less than what my massage therapist makes per session.
I have been in full-time private practice for a year now, and I love the freedom. However, it does come at the cost of uncertainty. Insurance companies are the main reason we get paid so poorly, however they are also the reason I keep getting new clients. Until seeking help for mental health becomes commonplace we will have to depend on insurance reimbursements.
I have two questions for you.
Are insurance companies open to re-negotiating the reimbursement rate? If so, which companies are open to it?
If I were to employ counselors who were not yet independently licensed, how do I charge for their services? Does it bill under my name, or do they only see self-pay clients?
Thanks you.
Can a provider bill 2 seperate insurance carriers for 1 45 min non married couple therapy session and collect 2 copays in the NYS ?