The big question for healthcare providers today: Should I accept Health Insurance?
Fresh graduates as well as seasoned clinicians either in part or full-time private practice have to decide whether to accept health insurance.
It is not easy to answer the question as the final decision will definitely 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 information which were misstated by counselors struggling with the issue of accepting insurance. I would like to offer you some useful words to 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.
It is true that some clinicians were successful, however, a lot of counselors encounter the problem of maintaining a large enough cash-paying client base to survive. On the other side, it does not have to be a problem for counselor who is interested only in a part-time practice, or has another income.
2)”Is it true that 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 the 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. However, 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 the insurance is the best choice for you.
3) “Is it true that it is not possible to deal with insurance companies?”
Well, if you face a common business such as receiving payments, submitting claims, there is no problem to cooperate with the companies. But if you require more complicated operation, e.g. unpaid claim, you have to keep your 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 when insurance companies do not want to allow care to patients with particular diagnoses, for example “V codes” ( such as problems with relationships, academic troubles…). That is to say, to obtain payment for services, some counselors assign a different diagnosis, such as Major Depressive Disorder, which is considerably far from patient´s symptoms.
5) “I refuse to do all the additional documentation.”
A private practice that accepts insurance differs from a more bureaucratic institution, for example a hospital, or a government-run medical clinic.
Being a licensed counselor, all you need as a licensed counselor is to take clinical notes – or a diagnostic assessment, plan of therapy, and SOAP notes every appointment.
Basically, insurance companies do not require your records as well as they do not state how to do your record keeping. However, they demand codes of procedures, patient diagnoses and service dates.
6) “I don´t want someone to dictate me 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.
Explaining Rumors about Insurance, Not Defending Them
In this article, we examined 6 generally known rumors about accepting insurance. I do not claim that insurance is the right for your practice. The decision has to be considered thoroughly before its approval.