Should I Accept Health Insurance? A Millennial’s Perspective

insuranceA few months ago, I made a startling realizations: I’m getting older.

Yes, it is unfortunate (but inevitable) that I will be finding imperfections concerning my body more frequently for a while, and I’m also learning how ill-prepared I am. The realization I pointed out earlier started out innocently enough when I found a gaping hole in my tooth. I was lucky enough to avoid things like braces and frequent visits to the dentist as a kid, but that luck has clearly run out.

Scared and confused (because I haven’t been to a doctor in years), I called up several dentist practices nearby to set up an appointment.

“What is your insurance plan?” they all would ask.

“Oh, I don’t have one.” I would reply.

*Click*. (That means the phone has hung up)

I learned the hard way that having the right insurance is instrumental to getting premium care for anything, especially dentistry. Luckily, I work in the mental health field, so I now have great insurance that stretches from medical to dentistry.

I am now experiencing “insurance entitlement.” This means I expect to be able to use insurance for anything medical, since that is what I have found to be the norm.

My story isn’t meant to be a depressing one, just a cautionary tale. I hear stories from counselors and clinicians (some of them being veterans) who don’t believe millennials like me will always be calling up people asking to pay cash for medical treatment. The fact is that “insurance entitlement” is something my generation didn’t create, but is clinging to.

I’m writing this piece on this particular site to stress something extremely important: you need to get on insurance panels! Millennials like me are counting on it.

Why Wouldn’t You want to Accept Insurance?

With the ACA, every one will be required by law to have insurance. Do you think they will continue to pay out of pocket / cash when they can go down the street and use their insurance?

Here are the 6 most common objections and easy answers to those objections:

1) “You should not accept insurance.”

Do you remember how your parents used to tell you: “Don´t do drugs”? Some 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 medical professionals 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 medical professional 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. But with 2014 coming, will you still be able to?

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.

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