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Applying for Insurance Panels

Posted by Stephanie Adams on June 17, 2011 at 11:09 AM

I'm almost done with my internship. My clients are asking me when I can start using their insurance. What can I tell them?

For many interns, one of the most exciting things about being finished with their internship is being able to apply to be on insurance panels. But - surprise! - a lot of interns don't know how to do this. In fact, becoming an insurance provider is something I'm still learning myself. But I can tell you what I know so far, and hopefully that will be enough to get you started.

In order to start applying for insurance panels, you'll need to read the fine print. And then re-read it again. And then talk to a representative, and your supervisor, and the office manager of your group. Simply put, it takes a lot of time. But if you want to do this, just suck it up and put aside the hours. After you're done, at least you won't have to do it again...except, of course, to update your information.

There's going to be a few restrictions: check restrictions related to your particular licensure, (do they insure LPCs? LMFTs? LADCs?) type of service provided, and geographic area. Checking geography simply means if your area already has "enough" providers, you might not be allowed to apply to be a provider with that insurance company.

There's going to be some companies, especially government companies, that require certain paperwork and policies be in place to qualify for coverage. For example, you can't bill most (any?) insurance panels for no-shows. Some insurance companies try to prevent you from personally billing the client for no-shows either! Still more may not want to take you until you've had a certain number of years in practice. (Unfair!)

Once you decide with which groups you want, you will need something called an NPI number, which stands for National Provider Identification number. (Don't confuse this with a tax ID number, which is your SS# if you're self-employed/sole-propreitorship, or your employer's company tax ID number in most other cases.) You can apply for your NPI number at the National Plan and Provider Enumeration System (NPPES). 

You'll need more information on hand to apply: Your liability insurance information, your counseling license number and expiration date, sometimes professional references, (contact information, not reference letters) school information and internship information. Oftentimes providers will request you first apply with a centralized credentialing agency, such as CAQH. This is a pain the first time, but then makes life easier because individual insurance companies can refer to that to verify your information, generally without additional action on your part.

Then, you wait. As of now, I have only been granted provider status at one major insurance company, and that took at least 6 weeks. I found out I was approved when a client called looking for me as a network provider, the letter notifying me of this fact didn't come until a few weeks after that. So if you have clients asking about timing, the safest answer is "a while."

You now know a little more about how to apply for insurance panels, but no doubt you've all heard of the controversy of whether or not to accept insurance period. On the one hand, it DOES compromise client privacy. On the other hand, unfortuantely many clients don't care and will not go to counseling if it is not covered by their insurance. It takes much longer to get reimbursed from insurance (and they will take any option not to reimburse) but you also get clients from their listing of in-network providers. It's a cost-benefit analysis, like so many other things. What aspect matters most to you?

What do you guys think? Are you planning on applying to be an insurance provider? Why or why not?

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Reply Dr. Sonja
3:33 PM on June 17, 2011 
This is a tricky one! Also know that some insurance panels require you be 3 years post licensure, and you will need HICFA forms to submit if you don't have a biller.

Following are the pros and cons, from my experience as a therapist who is a preferred provider for a couple of panels.

*Affordable therapy for your clients

*The more therapists accept insurance reimbursement, the more people expect their insurance to pay for their therapy. No one expects their insurance to pay for a life coach.
*Many of our clients are dealing with V codes, not major psychiatric diagnoses. Many policies do not cover marriage counseling (90847) or relationship issues or ACOA issues. Thank God for the old adjustment disorder with mixed anxiety and depression standby.
*You will get poorly paid for working with insurance companies. As a licensed clinical psycholgist, I get $70 an hour from United Healthcare (and have not had a raise in the 6 years I have been with them) and $78 for Aetna. Cigna pays $60!!!

Many of us would rather make $60 an hour than $zero an hour. And where I live, many therapists with good reputations and more experience than I have accept insurance, so I am at a bit of a loss. But I am constantly working on how to wean myself off of this "bad breast". Offering groups and working with a group of therapists who can refer to my groups is one solution I have found to this problem.
Reply Stephanie Adams
3:50 PM on June 17, 2011 
Dr. Sonja,
Thank you for your insightful and thorough response. It is helpful to have the perspective of someone with so much experience! Right now I'm not using my provider status with the one company for my new business ( because the difficulty of reimbursement for telemental health. But, supposedly TX is in the process of making it mandatory for insurance panels to cover teletherapy, so I'm wondering if I should pursue it. But I feel your experience. An experience counselor I know generally charges $125 full fee to clients, and gets reimbursed $45-75 from insurance companies. And they decide what we're allowed to treat them for. Difficult!! I appreciate your help - please continue to share your insights with us! Thanks again.
Reply Carol
12:58 PM on June 20, 2011 
I'm one year out of school and am in private practice. I have been approved by one insurance company (BCBS-NE, by listing under my supervisor, who is a BCBS-NE provider). I could also apply to be part of Medicaid (since I live in a rural area outside of Lincoln/Omaha, their requirements) but am choosing not to at this time because of paperwork and having to be in a group to file under one NPI number.

All other insurance companies I've contacted require that I have a full license before I can apply with them. Currently I have a provisional license (for 2-5 years while inquiring 1500 direct contact hours with clients under a supervisor).

I have my own NPI number and my own tax ID number (I prefer not putting my personal SS# on my forms that clients would have access to such as a super bill). The majority of my clients are self-pay so i do a lot of "fee forgiveness." My full fee is $75 (most fully licensed therapists in my area charge $100-$125). I will "fee forgive" every other session. My perspective is that I am able to get more clients this way so that I can more quickly reach my 1500 hours, so I can then get my full license and begin to up my rates and register with more insurance companies.

Another thing I've found beneficial is to register with Employee Assistance Programs. Some (i.e. Best Care EAP at Nebraska Methodist Health Systems) accept provisional licensed therapists and they contract for $65 a session.

I've started a group and charge a small fee per person and people are very receptive to this. I hope in time to get more groups going.
Reply Sean Paul Stanek
3:41 PM on June 28, 2011 
Great post Stephanie!

Carol, glad to hear that you have found a creative way to get clients in the door! Also, I am glad that you are able to work with Best Care. We are a pretty good company. :)

To add my 2 cents: The attitude of people in my area seems to be that they will not pursue counseling if you do not accept insurance. I am also provisional in Nebraska (or under clinical supervision) so becoming a provider can't happen for the next few months. I do plan to take the leap to private practice so I can increase my caseload. I know that insurance will be a part of this, but I think that by offering other "products" can make up the difference.

Take care!
Reply Beth Foster
6:55 PM on June 28, 2011 
I am also appyling to panels and have been working with BCBS-TX under my Substance Abuse licensure, I am certified to do Substance Abuse Professional evaluations for the US DOT and have gotten on a couple of employee assistance plans - this brings in a few dollars but most folks are terminated when they have a need for this service. I also do interventions - of course, this is not covered under any insurance coverage either but I have found that I need to diversify while getting the hours I need for full LPC licensure. I like the idea of a group, too - I have been considering starting a recovery maintenance group for addictions. Any ideas are greatly appreciated- for instance, when marketing a group do you send out flyers to local agencies?
Reply Stephanie Adams
3:20 PM on June 30, 2011 
Beth - I think flyers at a local agency would be great, but it might be even better to see if you can partner with someone in the agency to help you spread the word. See if you can talk to someone and share your enthusiasm, and they can help you find clients! You might also consider giving a freebie, like a free first session or information sheet, something to make you stand out!
Sean - I am feeling similarly about "having" to offer insurance, but have decided it might be a good thing because in Texas many insurance companies are starting to cover teletherapy, which I'm doing. I'm applying to UBH, Cigna and Medicaid. I'm already contracted with Aetna but still cannot figure out how to get started changing information in their system. Their online practitioner software doesn't work with my Mac or my husband's (brand-new) Tablet PC. Not sure how I'm supposed to work with that.
Carol - I'm excited to hear how your group will turn out! Thanks again for sharing.I'm curious to hear more about your "fee-forgiveness". When I was an intern I did sliding scale, mostly on the lower end, but like you said, interns need hours, so it works for both parties! Do you have any trouble with no-shows on days you don't charge? Do you charge a no-show fee? Sounds like you're an innovator! Keep us up on what you're doing!