The big question for healthcare providers today: Should I accept Health Insurance?
Fresh graduates and seasoned clinicians, either in part or full-time private practice, have to decide whether or not to accept health insurance.
This isn’t an easy question to answer because the final decision will certainly influence your counseling practice by the fact that accepting the health insurance means accepting third party payments. You have to take into consideration a lot of information, as well as misinformation conditioning your cooperation with insurance companies.
In this article, you will find 6 pieces of information that have been misstated by counselors struggling with the issue of accepting insurance. I would like to offer you some useful words for each of them:
1) “You should not accept insurance.”
Do you remember how your parents used to tell you: “Don´t do drugs”? Some counselor´s mentors can give you a parallel advice: “Don´t do insurance!”
Setting up a cash-only practice is a tempting idea. You do not have to worry too much about billing, and you can determine your own prices for provided services. The drawback is that establishing a private practice, either with insurance or without it, is not easy – setting up a “cash-only” practice is even more difficult.
While it is true that some clinicians have been successful with this, a lot of counselors encounter the problem of maintaining a large enough cash-paying client base to survive. On the other hand, it does not have to be a problem for a counselor who is only interested in a part-time practice or has another income.
2) ”Insurance companies don’t pay well.”
It is generally known that some insurance companies do not pay enough, but it is not a truthful statement for all companies.
According to my survey, an intake appointment (90801) pays around $100 for a specialist with a Master’s degree. The further individual therapies (90806) bring around $75-87, and couples counseling sessions – more than $10.
(Note: I am speaking about 45-minute therapies, not 1-hour therapies.)
If a counselor can put together their client schedule with clients who are willing to pay in cash, perfect! In such a case, it is senseless to accept insurance.
If there are gaps in your schedule, or if your sliding scale is critically decreasing under the level which would be otherwise paid by insurance, then insurance is the best choice for you.
3) “It is not possible to deal with insurance companies.”
Well, if you face a common business, such as receiving payments and submitting claims, there is no problem with the companies. But if you require more complicated operations, e.g. unpaid claims, you have to have incredible patience. Phone calls take some time, and you will not avoid exhausting switching from one line to another.
The cooperation with insurance is not infeasible. However, you can leave it to a billing company, which you can easily hire for a small cost – 8% of what they collect. There are also client co-pays and deductibles (money you receive from your clients), so the final cost is about 5.5% of your gross income.
4) “I refuse to be a slave to/employee of insurance companies.”
As a part of an insurance company network, you are not its employee or slave. You are affiliated (i.e.credentialed) – you were approved to bill insurance for certain services that you provide to their insured clients.
There is a hitch in case insurance companies do not want to allow care to patients with particular diagnoses. For example: “V codes,” such as problems with relationships, academic troubles and so on are frowned upon.
To obtain payment for services, some counselors assign a different diagnosis, such as Major Depressive Disorder, which is considerably far from the patient´s symptoms.
5) “I refuse to do all of the additional documentation.”
A private practice that accepts insurance differs from a more bureaucratic institution, such as a hospital or government-run medical clinic.
As a licensed counselor, all you need is to take clinical notes – or a diagnostic assessment, plan of therapy and SOAP notes for every appointment.
Basically, insurance companies do not require your records, and they do not state how to do your record keeping. They do, however, demand codes of procedures, patient diagnoses and service dates.
6) “I don’t want someone to dictate what clients I have to see.”
Let me clarify this misinformation. Being networked with an insurance company does not mean that you have to see only some specific patients or clients. You still have the option to choose your clients.
In this article, we examined 6 generally known rumors about accepting insurance. I do not claim that insurance is absolutely right for your practice. The decision has to be considered thoroughly before its approval.