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. 

Cons:

  • 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. 
Pros:
  • 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