Wednesday, August 28, 2013

How An Intern Becomes An Insurance Provider [Classic Beginning Counselor]

To celebrate the new blog location for Beginning Counselor, I've collected and updated some classic blog posts for you. Enjoy! 

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. (Fact is, a great deal of it STILL mystifies me, and I've been licensed since 2011!) 

The rules are always changing, and there's no manual that's user-friendly. So it's no surprise many interns want to get on panel but get continually frustrated by conflicting instructions. Don't give up! That's what "they" want you to do. 

No lie, it's going to be a lot of work. But if it's something you want, it can be done. So take a deep breath, and let's dive in together.

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 after you're done, at least you won't have to do it again...for a little while, anyway.

Start by checking out the restrictions: 
  1. Related to your particular licensure. (Do they insure LPCs? LMFTs? LADCs?)
  2. Related to the type of service provided. 
  3. Related to the 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 may also prevent you from 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.

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-proprietorship, 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. I found out I was approved for one insurance panel 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. Every counselor has to look at their situation and the needs of the clients they serve, and make the choice that is best for them. Here are some of the things they must consider. 


  • Billing a client insurance company compromises client privacy. You are often required to provide justification for your services based on a diagnosis (now on the client's record permanently) and a treatment plan. 
  • It takes providers much longer to get reimbursed from insurance, and insurance providers will take any opportunity not to reimburse you. It is common to have to bill 2-3 times to get reimbursement.
  • Contractually, the reimbursement for therapy services at the time of this writing for LPCs is usually $25-65 for a clinical hour. If you have a PhD, you may be able to command rates of $80-90. In my experience, this has been true more often than not.
  • Lower payment commitment from client can translate into lower commitment to therapy process and attendance. 
  • While insurance DOES compromise client privacy, many clients don't really care about that. Additionally, they will not (or cannot) obtain counseling services if they are not covered by their insurance. 
  • You get client referrals just from the insurance company's listing of in-network providers. 
  • It can lower client's resistance to starting therapy. 
  • It can be an act of service for a client who really needs it. 
  • For interns, it can be a way to jump-start your client load. 

To take insurance or to not take insurance is a cost-benefit analysis, like so many other things. What is most important to you? 

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

A version of this article was originally published 6/17/11

Thursday, August 22, 2013

My FIRST-EVER Video Blog!

Want to see what facing a fear looks like? This is it. Check out this video response to a question submitted by a Beginning Counselor, and comment below to let me know what you think. And send in your own questions! You never know what might make my next video blog response!

Sunday, August 11, 2013

[Early Edition] What's Newsies got to do with it?

When we moved into our new place, part of our new cable package (to my delight and distraction) was an extended movie bundle. This led to endless re-viewings of some of my old favorites from The Parent Trap, Freaky Friday....and Newsies.

Remember Newsies? The endlessly joyful, underdog triumph story starring a very adorable (and hopefully 'of age') Christian Bale, Bill Pullman, and Robert Duvall?

This story took a new meaning to me this morning as I reflected on two developments within our community.

One is the imminent (August 12) decision point to be made by the Texas LPC board as to whether to needlessly restrict the wording on the rulebooks to bar online counselors from using technology-assisted counseling with new clients - limiting agoraphobic, physically disabled, ill, remotely located, and countless other clients from utilizing an EVIDENCE-BASED counseling practice to get much-needed help.

Second is a frustrated plea for help I heard from a new counselor  - why can't I get a job that will pay the bills? I love what I do, I want to help people, but the agency jobs out there don't pay enough to make ends meet.

What can these two diverse developments possibly have in common with one another, let alone Newsies?

Both can be affected if we LET OUR VOICE BE HEARD.

The petition started by Donna R., online counselor in Austin, Texas, that I shared with you through this blog, and through Twitter, Facebook, Pinterest, and other social media outlets, went from 5 to over 70 signatures in the span of a day. We still have time to grow it even further before the deadline tomorrow if you will click HERE and request that mental health parity be served by leaving the Texas LPC rule wording as-is.

I encouraged the new counselor - and I encourage you as well - to take your employment situation into your own hands. The demand for counseling services is growing and so sadly, is the downward trend in agency job availability. I believe this reflects the reality that many agencies will only be able to offer poorer and poorer services to clients, which in turn, opens up the demand for counselors in private practice. You can sign up for 30 Days To A More Profitable Private Practice (30 days of absolutely free tips on how to skyrocket your private practice growth) here and/or get a month of free training from MBA In Private Practice - my training program with Dr. Deb Legge that teaches you how to build a profitable, sustainable business from the ground up by clicking here.

There are solutions out there - you just have to refuse to accept anything less and get the word OUT there!

As Christian Bale says at the moment of the Newsies' victory,

"They got voices now, and they're going to be listened to...that's the power of the press, Joe!"

Seize the Day by Newsies Cast
Music by Alan Menken.
Lyrics by Jack Feldman.

Open the gates and seize the day
Don't be afraid and don't delay
Nothing can break us
No one can make us
Give our rights away
Arise and seize the day 

Now is the time to seize the day
Send out the call and join the fray 

Wrongs will be righted
If we're united 

Let us seize the day 

Friends of the friendless, seize the day
Raise up the torch and light the way
Proud and defiant
We'll slay the giant
Let us seize the day 

Neighbor to neighbor
Father to son
One for all and all for one 

Open the gates and seize the day
Don't be afraid and don't delay
Nothing can break us
No one can make us
Give our rights away 

Neighbor to neighbor
Father to son
One for all and all for one

Sign the Petition: Seize the Day!

Free Month of MBA In Private Practice: Seize The Day!

30 Free Tips To A More Profitable Private Practice: Seize The Day! 

Thursday, August 8, 2013


Texas LPCs, I have just learned from a kind colleague today that the Texas LPC board has proposed rule changes which would prohibit us from initiating counseling with new clients online - using technological means for counseling would would be permitted for existing clients who have been seen in-office previously. This unwarranted change would restrict your ability to serve future clients for years to come, including many who would not otherwise be able to access counseling services. If you've ever thought about providing services online, this affects you.

The deadline for objecting to the proposed rule change is August 12, 2013. I URGE you to write to the LPC Board here:

Please submit your comments to, or

Here are a few pointers from the Texas Counseling Association for for making effective comments to the LPC board :
  • Keep in mind that the mission of the LPC board is to protect the interests of the public, not counselors. Therefore, frame your comments in terms of how this change would affect clients.
  • Reference the proposed rule change, and suggest specific changes to be made to the proposed rule (or alternately you may suggest that the current rule which allows online-initiated counseling be allowed to stand as written).
  • Be as succinct as possible.

You can view the proposed rule changes here:

The proposed change is underlined on the top of page 17. (Adobe Acrobat)

As a fellow mental health professional, I would like to share my reasons for opposing the proposed change to the LPC rule which states:

Technological means of communication may be used to facilitate the therapeutic counseling process which has already been established. Technological means may be used in crisis counseling with no previous counseling relationship.

Thousands or Texans will be denied access to needed counseling services as a result of the proposed change. Texas counselors, including myself, have been ethically practicing online counseling for a numbers of year now with great success, and just as in my practice, quite a few clients WOULD NEVER have initiated treatment in-person. This is an unnecessary barrier to treatment, especially affecting underserved populations including the sick, disabled, geographically remote, and those with certain disorders such as agoraphobia, as well as other reasons. Moreover, this restriction is possibly discriminatory and undermines mental health parity.

There is no empirical justification behind making this restrictive change, as studies have repeatedly shown online counseling to be just as effective, and in some cases even more so. These studies have not made a distinction between counseling initiated in-person versus online. Please reference the World Health Organization endorsement of online therapy and this list of studies showing the effectiveness of online therapy.

I will be spreading the word to my other Texas colleagues and urge you to contact the board as soon as possible to overturn this proposed restriction. I appreciate your time and thoughtfulness in this matter.

Thank you.

Stephanie Adams, MA LPC

P.S. Even if you DON'T plan on offering online therapy, if you're in Texas, would you send an email on behalf of the many counselors such as myself who hope to ethically continue to offer online services without needless restrictions to our clients? This could cripple counseling businesses such as mine and more importantly, turn people away from therapy who need it. Please send your respectful objections on their behalf.

P.P.S. You should feel free to adapt and use information in this blog post today as necessary to write your letter.

REMEMBER, you have to send email before August 12th. Please comment below if you have sent that, so I can reference in a follow-up email to Ms. Alexander.


For further reading: Conservative attacks on online therapy.
FYI: Original Rule for LPCs In Texas reads:

Subchapter C. Code of Ethics. §681.41. General Ethical Requirements. (g) Where the client is in one location and the counselor is in another, technological means of communication may be used to facilitate the therapeutic counseling process.

A huge debt of thanks goes to Donna Rose, LPC, Counselor in Austin, TX. She told me about this change and took the time to help me draw up a post about this information on really short notice. I literally could not have done anything without her help. Thank you, Donna!