Featured Articles An Update: The New Parity Law and What it Means for You, by Barbara Griswold, LMFT (February 27, 2010) Becoming a Network Provider: Selling Yourself to Insurance Companies, by Barbara Griswold, LMFT (November 15, 2009) The Nuts and Bolts of Managed Care: Your Questions Answered, by Barbara Griswold, LMFT (September 10, 2009) 12 Ways to Get More Insurance Referrals, by Barbara Griswold, LMFT (August 12, 2009) The Top 10 (Mostly Preventable) Reasons Your Claim Could be Denied, by Barbara Griswold, LMFT (July 10, 2009) Taking the Pain Out of Billing: Office Ally is a True Therapist's Ally, by Barbara Griswold, LMFT (May 11, 2009) Employee Assistance Programs: A Free (But Not Well-Known) Benefit, by Barbara Griswold, LMFT (April 13, 2009) When Your Client Loses His Job: Insurance Loss, and What it Means for You, by Barbara Griswold, LMFT (March 15, 2009) Electronic Billing — With or Without a Computer, by Barbara Griswold, LMFT (February 15, 2009) Don't Get Lost In The Phone Maze: Tips When Calling the Health Plan, by Barbara Griswold, LMFT (November 15, 2008) A Program That WANTS to Help Your Clients Pay for Your Services?, by Barbara Griswold, LMFT (August 15, 2008) The New PTSD: Pissed at Those Stupid Deductibles, by Barbara Griswold, LMFT (June 16, 2008) An Update: The New Parity Law and What it Means for You By Barbara Griswold, LMFT (February 27, 2010) Back in November of 2008, I told readers about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). Well, it just went into effect, so here's an update on how your life may change because of it. FIRST, A REVIEW: WHAT IS THE LAW ABOUT? The MHPAEA requires health plans to provide coverage for mental health and addiction treatment that is equal to ("at parity with") coverage provided for the treatment of physical illnesses covered by the plan. It strengthens and expands previous parity laws, which were very limited in scope. It is estimated that approximately 1/3 of Americans will now have better coverage. Group health plans with more than 50 employees will no longer be able to impose limits on inpatient days or outpatient mental health visits if no such limit exists for medical visits. These plans won't be able to require higher deductibles or copayments for mental illness or substance abuse treatment than the plan imposes for medical treatment. In addition, if a plan allows your client to go out of their network of providers for medical care, it must also offer out-of-network coverage for mental. HOW WILL THINGS CHANGE FOR MY CLIENTS? 1. For some clients, their deductible may be waived or reduced, and/or the co-payment may be lower, meaning they may be able to see you more frequently — and longer — than they otherwise could have. 2. They may now also be eligible for unlimited sessions. 3. Some clients will have out-of-network coverage when they previously did not, or better out-of-network coverage. THE FINE PRINT? 1. The MHPAEA does not require a plan to cover specific illnesses, but applies to all diagnoses that a plan covers. 2. The MHPAEA supersedes state parity regulations if the state regulations are more limited. 3. Individual plans and businesses with 50 or fewer employees are exempt. EAPs are also expected to be exempt. 4. The MHPAEA doesn't require coverage to be "good" — it just needs to be equal to medical. Therefore, a client can still have a high deductible or copay or limitations, if their medical coverage does. 5. A plan is not required to cover any particular provider license (ex. MFTs or LPCs). THE MOST CONCERNING CATCH? While large plans that have no limit on medical visits can no longer limit mental health or substance abuse visits, they retain the right to cover only "medically necessary" visits. Therefore, I think we will see plans making more of an attempt to review our treatment according to their criteria for medical necessity. This may involve more preauthorizations and data gathering, sometimes even for out-of-network providers. I don't think it is a coincidence that Anthem Blue Cross of California announced that many of their plans will now require authorization after the 12th visit. Blue Shield of California recently notified providers in one of their plans (the Federal Employee Program PPO) that they must now must get preauthorization, and — beginning March 22nd — submit an Outpatient Treatment Plan prior to the third visit. BE POSITIVE! But, before we get too pessimistic about paperwork treands, let's take a moment to enjoy this. Something truly historic and wonderful came out of Washington! At a time when the lack of progress on health care reform is pretty depressing, it is nice to remember that — not that long ago — our representatives were able to get something pretty important passed. For more details on parity and how it will affect you, I recommend this helpful article: http://www.apapracticecentral.org/news/2008/wellstone-domenici.aspx To get the manual that answers all your insurance questions, click here, or to set up your insurance consultation with Barbara, click here. [ back to top ] Becoming a Network Provider: Selling Yourself to Insurance Companies By Barbara Griswold, LMFT (November 15, 2009) I enjoy telling therapists that when I joined my first insurance plan 17 years ago, it seemed the only condition for joining was a pulse. Many panels required little more than an application and resume. Those days are gone. In many areas of the country, insurance plans just have more applications than they need, so they are often closed to new providers. Since it is expensive to maintain a large provider network, it is in the plan's best interest financially to maintain the fewest number of providers. However, they are also required to maintain a minimum number of providers with a variety of specialties to serve their members in any area. So, let's say you want to join a provider panel. Where do you start? • Must you wait two years? It's true that many plans say they won't accept you until you have been licensed two (or more) years. However, don't let this stop you from applying. A plan may land a new employer account and need to add providers quickly and unexpectedly, and may dig into their application file. Also, exceptions may be made if you have a needed skill, specialty, language fluency, location, etc. • Get a list of insurance plans. Your professional organization (ex. CAMFT) or state Department of Insurance may be able to provide you with such a list. Psychotherapy Finances (www.psyfin.com), a must-have monthly newsletter for therapists, has a section alerting readers to insurance panel openings. Also, contact Fran Wickner, MFT, (www.franwickner.com) for a list of 60 plans and their contact information, available on mailing labels. • Develop a letter of interest and resume that is specifically targeted to insurance plans, and highlights the kind of experience and specialties you have that a plan would be looking for. (For help creating a dynamic targeted resume and interest letter that will make plans take a second look at you, click here and we'll set up your personal phone consultation). • Use your time effectively. While you can call each plan or visit their Web site to see if they accept online applications, if you want to limit the time you spend on this project, do a blanket mailing, submitting your resume and letter of interest by mail to all plans on your list, even if they say they are full. If you are sent an application, you can ask any questions you may have at that time. • If you are told the network is closed, or get no response, call the plan and try to sell yourself. Find out what needs they have in your area that might make them consider/reconsider your application (subletting a second office for a few hours each week in an underserved area? Leading a group? Getting CISD training? • If turned down, reapply every six months. Eventually, through attrition or an increase in the plan's membership, there will be openings on the panel, and your efforts will pay off. • Keep a log with dates of actions you took, phone calls made, names of people you spoke with, and their advice. • If you get frustrated, remember why you are doing this. Insurance referrals can account for thousands of dollars of income to your practice, and help keep your practice full. For more advice about what plans are looking for, what to highlight in your cover letter, how to answer application questions, and all other questions about insurance, click here to purchase my insurance manual, Navigating the Insurance Maze, or to set up your consultation. The Nuts and Bolts of Managed Care: Your Questions Answered By Barbara Griswold, LMFT (September 10, 2009) While I enjoy discussing the ethical and moral dilemmas of managed care, today's article focuses on the basics of working with insurance. So here are the answers to a few frequently asked questions. How often should I submit claims? I recommend billing at least monthly. Otherwise our busy schedules and distaste for billing may allow large balances to accumulate, which can mean trouble if the plan doesn't pay. Also, if you've signed a contract, they may require you to bill within 60 or 90 days. When billing each month, check the status of unpaid claims so they get overlooked. How long does it take to be paid? It depends on the plan, and on how you submit the claim. It can be as fast as two weeks if you submit electronically, so consider this option (see my past articles on electronic billing for more on this option). Many plans allow you to submit claims and track claim status at their website. Call the plan if you haven't received a response to your claim within six to eight weeks. Do all plans accept the universal CMS-1500s/HCFA claim form? Most do, though some employee assistance programs (EAPs) require their own forms. How do I keep track of all this? Record the submission date and payments in the client's chart. My book Navigating the Insurance Maze includes a sample Service Record that I use for tracking claim submissions and all payments, both from clients and the plan (click here for book info). It's also a good idea to keep a copy of paper claims. One way to do this is to purchase carbonless duplicate claim forms (to purchase claim forms, click here). Must I fill out a new form every time I bill? No. Many therapists partially fill out a claim form for the client at the first session, leaving the session-specific information blank. Each time they bill, they use this as a template, making a copy, and filling in the new information. However, claims submitted on original red CMS-1500 claim forms (not copied) are usually paid MUCH more rapidly, since they may be computer-scanned. What if I make a mistake on a claim I sent in? Submit a corrected claim (another claim — without the mistake). Attach a note stating that it is a corrected claim so it isn't rejected as a duplicate. Will insurance cover phone sessions? Most plans don't. Some plans (like USBH California) will when it is deemed clinically necessary and pre-approved. Use a phone session CPT code; it is fraud to give the appearance that you met face-to-face. If the plan does not cover calls, your contract (if you have one) may allow you to bill the client if he signed a written agreement, but may limit your fee to your contracted rate. What about missed sessions? Most insurance companies will not pay for these, either. Contact the plan or check your contract. If you do bill, ask the plan what CPT code to use on the claim. Again, some plans will allow you to bill the client only when there is a written agreement, and your contract may limit your fee. Will the plan cover EMDR or hypnosis? This varies by plan. CIGNA allows designated providers to bill for two-hour sessions of EMDR. Some plans, like Managed Health Network, will pay for EMDR, but not as a "stand-alone" treatment. Others won't reimburse for EMDR at all. Hypnosis is often covered, but usually only as part of a treatment plan. Can I bill for extended sessions? Most plans cover one hour of therapy per day (some allow one hour per week). Longer sessions may require pre-approval. An insurance rep told me it could be considered fraud to report a one-hour session when you actually provided a longer one. She advised that the claim should reflect the actual session length; the plan will simply pay their maximum (probably the amount for a 50 minute session). This may not be how all plans want you to handle this situation. As always, contact the plan for coverage information and coding advice. Have insurance questions? Want more practical tips? Purchase Barbara's insurance manual complete with sample forms and line-by-line claim form instructions (click here) or schedule a consultation with Barbara (click here). [ back to top ] 12 Ways to Get More Insurance Referrals By Barbara Griswold, LMFT (August 12, 2009) So let's say you have signed contracts with insurance plans, but you still aren't getting many clients from the plans. What can you do? 1. Call the insurance company and ask about your current network status. You may have accidentally been removed from the network or placed into "limbo-listing." This is when you have not been terminated from the network, but you have lost your active status. This can occur due to a computer error, or if the plan does not have a copy of your latest liability or license. 2. Is your information current? Call the insurance company's Provider Relations or Network Management department to make sure your contact information, list of specialties, and address is up to date. 3. Check what clients are seeing about you on the plan's Web site. Are you even on the online provider list? If so, are you listed in the appropriate section, and as "taking new clients"? Is your other information correct? Some plans (like CIGNA) allow you to post a provider profile and personal statement to describe your practice and your treatment approach. Yet surprisingly, CIGNA reports most of their therapists have not taken advantage of this free advertising. I am often told by clients that they selected me due to what I said in this statement. 4. Create your own Web site where potential clients can learn more about you. I can't stress this enough. Research shows that most clients will Google your name before calling you. This is even true if they have been given several possible referrals, or have a list of names from their plan's online provider directory. Going to see a therapist who you know nothing about is like a blind date — clients will almost always choose the "date" they know something about. If you have a Web site, get some non-therapists to give you feedback, and have experts advise you on how to increase your traffic. If you don't want to pay for a full Web site, consider online therapist referral sources within your specialty, your community, your professional agency, or general referral sites such as PsychologyToday.com. 5. Be sure you are on the list for all the company's plans. Perhaps you joined the CureQuick PPO plan but were not automatically placed on the HMO or EAP network provider list. 6. Let the plan know if you are willing to provide special services. Some plans will make more referrals (or even pay incentives) to therapists willing to see clients in special situations, such as emergency referrals, or clients who are newly discharged from the hospital. Being able to provide Critical Incident Stress Debriefings (CISD) or teach employer-requested trainings or lectures might also get you referrals. Consider adding groups that insurance plans might be seeking, and advertise them to the plans. You might also tell the plan if you are available on weekends, a much-needed service, or provide services to military families. 7. When possible, in your advertising, state that you accept insurance. It can be a great idea to even list the plans you accept. Especially in this economy, if a client already knows you accept her insurance, you may be the first therapist she calls. 8. Let colleagues know what insurance plans you accept. For example, all the therapists in my building have developed a referral list, where we can instantly see who among us is a provider for any given network. This has proved a very well-used referral tool for all of us. 9. Adding a specialty to your bag of tricks can increase referrals. Becoming a Certified Employee Assistance Professional (CEAP) or a Substance Abuse Professional (SAP) qualification could increase referrals. 10. Offer to contact a new caller's insurance plan and investigate coverage — even if you don't think you are covered by their plan. This can lead a grateful client to choose you, even if you aren't covered, or if you are only covered as an out-of-network provider. 11. The early bird catches the worm. Return phone calls from new clients promptly. 12. The no-brainer: Call and ask the insurance company what you might do to get more referrals. They may have a sense of their needs in your area. For the manual that answers all your insurance questions,click here, or to set up a personalized consultation, (click here). [ back to top ] The Top 10 (Mostly Preventable) Reasons Your Claim Could be Denied By Barbara Griswold, LMFT (July 10, 2009) Managed care plans report these common situations that lead to claim denials (notice how many of them could be avoided by asking the right questions at the start of treatment): 1. Diagnosis issues. One of the biggest issues tripping up therapists is failure to use the full number of digits required for a diagnosis. Most commonly, five digits (two to the right of the decimal) are required, though some diagnoses have only three or four digits. Most plans require an Axis I or II diagnosis (except for EAPs, which allow V-code diagnoses). And be sure to use the diagnosis code — don't simply write the name of the diagnosis. 2. No authorization on the date of the session. Be sure to get necessary authorizations, keep track of expirations, and take care not to exceed the number of allotted sessions. 3. Yearly session limit has been exceeded. Be sure you keep track of the number of sessions used. Remember that not all plans run on the calendar year — for example, some give clients 20 sessions over a 12-month period from the start of treatment. 4. Wrong claims address. Always call the plan in advance to check the claims address. Never trust the address on the health plan card, one a client gives you, or even the one given by the automated phone service at the health plan, as it is often not the one for mental health claims. 5. The claim was incomplete or illegible. If you submit paper claims, review them carefully to be sure you fill out all necessary boxes, and work on your clear block printing! 6. Wrong codes. You may have used a CPT code for a type of service other than the ones that were authorized, used a code they do not cover, or used a non-existent code. Or you may have used the wrong Place-of-Service code. You may have written "O," "OV," "OFF" or "Office" to stand for office, instead of the required "11" for "office." 7. The claim was late. Some plans require the claim be submitted within 60 or 90 days. If your claim is denied for this reason, the plan may not allow you to bill the client. 8. Incorrect claim form. Most plans require the newest version of the CMS-1500 forms (to purchase blank claim forms, click here), but some plans (including some EAPs) require their own claim forms. 9. The claim is being held, or "pended." Frequently, a claim is pended awaiting information from the member about "Coordination of Benefits." The insurer wants to find out if the client is covered by another plan. 10. The client was not eligible, or has a "pre-existing condition" exclusion. New employees sometimes have a period of time before their coverage "kicks in." Or if the client had a medical problem which existed at the time she enrolled, the plan may deny all claims pertaining to this medical problem for a certain period. For employer-provided coverage, the exclusion period is typically limited to 12 months. Have insurance questions? Want more practical tips? Purchase Barbara's insurance manual complete with sample forms and line-by-line claim form instructions (click here) or schedule a consultation with Barbara (click here). [ back to top ] Taking the Pain Out of Billing: Office Ally is a True Therapist's Ally By Barbara Griswold, LMFT (May 11, 2009) It's unusual that I come across a service that I think is so terrific that I would write an article about it, but get ready for the exception. Office Ally is a tool that ANY therapist can use to submit a claim to ANY insurance company (this includes Medicare, Medicaid/MediCal, and TriCare/Champus). It's easy, fast, and best of all, it's free. You don't need to be a plan provider. You can submit just one claim. Or you can submit a whole bunch of claims, and OA will sort them, convert them to a HIPAA-compliant format, and submit them electronically to the proper insurance plan. There is no need to purchase software. You need nothing more than an internet connection. Office Ally offers three options for claims submission. The first is a free online entry tool where you type data into a blank claim form on the website. You can store client and provider information so you do not have to re-type the same information each time you bill. If you'd like something more comprehensive, Office Ally offers "Practice Mate," a complete (and free) web-based practice management and accounting system, which can track sessions and payments, create client statements, and can even schedule appointments. And finally, if you already have your own practice management software which allows you to print claims, Office Ally can transmit your claims electronically. Once your software has created an image of your claims, simply upload these files at the OA website. The OA website will interface with all practice management software packages. Each claim is checked for errors such as invalid dates or codes. Once you submit a claim you will receive e-mails letting you know the status of the submission, and if it has been accepted or rejected by the plan. You may immediately fix many claim errors right at the website. You can also view a history of your claims submissions. The phone staff will walk you through the set-up process and your first claim submissions step-by-step. There are no fees for their customer service or tech support, which is available 24/7. I have found them to be very friendly and patient. The only exceptions to their "no-fee" policy: if you are billing a plan that is not on their list of over 2000 payers, you may choose to have them mail bills for you for just 35 cents per claim (less than the cost of a stamp). Also, there is a $19.95 monthly fee if more than 50% of your claims are Medicare or Medicaid/MediCal. Why is it free? Like all claims "clearinghouses," OA is reimbursed by the insurance plans (electronic submissions save the plans money). However, unlike most other clearinghouses, Office Ally elects not to charge the provider. Can you tell I am a big OA fan? I urge you to check them out at www.officeally.com or contact them at (866) 575-4120 or info@officeally.com. For complete advice about how to "navigate the insurance maze" — including how to sell yourself to EAPs and insurance companies to fill those empty therapy slots — order Barbara's book or schedule a personal consultation with Barbara. [ back to top ] Employee Assistance Programs: A Free (But Not Well-Known) Benefit By Barbara Griswold, LMFT (April 13, 2009) In a recession, it is sad that often clients don't realize that many companies offer a free mental health benefit to all employees — an Employee Assistance Program. This program provides employees and dependents with a small number of free counseling sessions each year with one of their contracted EAP network providers. The idea of the EAP is to provide assessment, short-term counseling, and referral. Studies show that when employees have access to free EAP sessions, this leads to lower absenteeism and higher productivity and job satisfaction. In addition to the free counseling sessions, some EAPs may also provide a few sessions of free legal assistance, financial/tax assistance, child care referral, and elder care referral. Here are some commonly asked questions about EAPs: How may counseling sessions does a client get? Typically three to eight per family member, sometimes more. Is the EAP part of the insurance plan? Sometimes the EAP is handled by the client's insurance plan, sometimes it is administered through a whole different company. Must I go to the worksite? While some EAPs are located at the workplace, most EAPs are made up of a network of community providers who provide services in their offices. What about confidentiality? Some clients worry that what they say will get back to their employers, especially in an EAP situation. But claims are processed by the EAP plan, not the employer, and only usage statistics are reported to the employer (unless the referral was employer-mandated). Can I continue with my client after her EAP sessions? In most cases your contract permits clients to continue, either paying privately or using mental health insurance benefits, as long as you've given multiple referrals. However, some contracts do not allow self-referral. What do you like best about being an EAP provider? Because the sessions are free, many clients come to counseling who would never have come if there was a fee. After "tasting" the benefits of therapy, they often choose to pay to continue. Also, in most cases no diagnosis of mental illness is necessary. Clients may discuss any issue, and usually need not have a diagnosis. What do you like least about EAPs? A client must get preauthorization and see a therapist on their EAP provider list. EAPs sometimes require billing forms that are different from the universal HCFA (CMS-1500) insurance billing form, so you may have to fill it out by hand. You may also have to fill out a brief form with some general case information. How can my client find out if he has an EAP program at his work? Have him check with Human Resources or check his insurance benefits brochure. How do I become an EAP provider? This is covered step-by-step in my manual (for more info on the manual, click here). I also published a list of the largest EAP companies in my January e-newsletter which can give you a place to begin. But getting your foot in the door isn't always easy: Many EAP provider panels are full, and some plans require extensive EAP experience or training. So to maximize your chances of acceptance, you may need to sell yourself to the companies. Highlight your experience in assessment (substance abuse assessment skills are a big plus) and brief therapy. For complete advice about how to sell yourself to EAPs and insurance companies, schedule a consultation. [ back to top ] When Your Client Loses His Job: Insurance Loss, and What it Means for You By Barbara Griswold, LMFT (March 15, 2009) When a client goes through a major life change like the loss of a job, the possibility of losing health insurance coverage may be the last thing on his mind. But it should be on yours, as losing coverage could impact therapy. Urge the client to find out if he is eligible for COBRA coverage. COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal statute that requires most employers to offer insurance to employees and dependents who would otherwise lose coverage. Who can get COBRA? COBRA is available for clients who lost coverage when they were fired, quit their jobs, had work hours cut to a level that they lost their eligibility for coverage, became disabled, divorced, lost their dependent child status, or when the employee died. This would entitle your client to continue with the same coverage he had while employed, but he would take over payment of the premium (the monthly or yearly cost paid to receive the insurance coverage). If your client switches to COBRA coverage, what does this mean for you? If the client submitted his COBRA application in a timely fashion and it was processed smoothly (you might want to get proof of this), not much changes in your therapy. You (or the client) keep submitting claims, and the plan continues to pay, as if nothing had changed, since all that has changed is who is paying the premium. What's the catch? Your client may get a letter from his company informing him about COBRA coverage, but it isn't always clear that there is an important deadline involved. Your client must act fast to sign up before the deadline so there is no break in coverage, as any break can jeopardize his ability to get later coverage. There are also limits to this continuation of coverage (usually 18 months for loss of employment or work hour reduction, 29 months for disability-related events, or 36 months for dependents who would lose coverage for reasons other than employment loss by the employee). Why not just purchase his own individual plan? When your client continues as part of an employer "group insurance" there is no need to go through an application for coverage. This means your coverage can't be denied or limited due to medical reasons and premiums may be lower. What about when COBRA benefits are exhausted? Your client may be eligible for an individual conversion coverage plan offered by the same plan that provided his group coverage. He can apply for an individual plan at any insurance plan. If your client has a medical or mental health condition that might make it difficult for them to get insurance, or if he needs free or low-cost insurance, he can contact the U.S. Uninsured Helpline at www.coverageforall.org or 800.234.1317 — it's a great resource for clients who are looking for coverage. For more information about COBRA, visit http://www.cms.hhs.gov/COBRAContinuationofCov. This article is adapted from Navigating the Insurance Maze: The Therapist's Complete Guide to Working with Insurance — And Whether You Should, by Barbara Griswold. To order, click here. [ back to top ] Electronic Billing — With or Without a Computer From Navigating the Insurance Maze: The Therapist's Complete Guide to Working with Insurance — And Whether You Should by Barbara Griswold, LMFT (February 15, 2009) Insurance, computers, and change — three things many therapists avoid like the plague. A 2005 Psychotherapy Finances survey showed that only 23 percent of solo practitioners filed electronic claims. Yet it is likely that paper claims will soon become obsolete, and plans will only accept electronic claims. So, what is electronic billing? Electronic billing is submitting claims to the insurance plan via the Internet. The biggest payoff with electronic billing is that claims are instantaneously received by the insurance company, which greatly speeds payment — sometimes cutting your reimbursement wait in half. And errors are usually caught quickly, significantly reducing claim rejection due to tiny issues such as a missing CPT code or an invalid diagnosis code. Here are the three most common types of electronic billing: Submit directly at the plan's website. No special software is required. Claims are filed immediately with the plan, without going through an intermediary. It's free and easy, even for the computer novice. A good option for therapists who have few claims and who work with a small number of plans.   Submit through a claims clearinghouse. This is a popular option for therapists who have (or are willing to use) billing software. The claims are transmitted from your software to a clearinghouse with whom you have contracted. The clearinghouse serves as a kind of intermediary, instantaneously converting the claims to a HIPAA-compliant secure format, then sending them to the appropriate insurance company. A good option if you work with many insurance clients or multiple insurance plans. Be sure to contact the clearinghouse to make sure the plans you bill are on their payer list, and that they can receive claims from your billing program.   Sound expensive? Believe it or not, there is at least one online clearinghouse, Office Ally (www.OfficeAlly.com) which will submit your claims for FREE. And there are low cost billing software programs (Office Ally even has FREE online practice management software you can use).   Submit through a billing service. Don't want to deal with computers or billing? Hire a billing service. After you send initial client data to the billing service, you might send a weekly list of clients seen with session dates and procedure codes), and the service will format and transmit the claims to the web site of the appropriate insurance company. The billing service may even follow-up on unpaid claims, track authorizations, and verify insurance coverage for you. Financial arrangements vary: They may offer flat-fee pricing, per-claim fees, or a percentage of your reimbursements.   Karen Rose, MFT, loves her billing service. "They do absolutely all paperwork for my practice, including billing, tracking claims, dealing with unpaid claims, credentialing and re-credentialing. In fact, I now print on the back of my business cards, 'for billing questions, contact…' with their phone number. My clients contact them directly regarding billing and insurance issues, and I can just do therapy." Sounds nice, huh? This article is adapted from my practical, quick-read manual of what EVERY therapist should know about insurance (click here to order). [ back to top ] Don't Get Lost In The Phone Maze: Tips When Calling the Health Plan By Barbara Griswold, LMFT (November 15, 2008) It isn't always easy to get through to the right person at an insurance company. In fact, it isn't easy to get through to a person at all. But here are some tips to keep in mind: Reaching Someone with a Pulse What time is it there? Make sure you call during normal business hours in the time zone of the insurance company's headquarters. If you are located in on the West Coast, this may mean calling before 2:00 pm. After-hours staff may have limited ability to help you except in emergencies. When possible, avoid high-call volume periods, such as Monday mornings.   Ignore the options. If an automated message comes on giving you options (e.g. "for the status of a submitted claim, press 1, for claims address, press 2"), try saying "Customer Service," "Representative," "Associate," or "Agent." If all else fails, press "O" or say "Operator."   Do nothing. If you do nothing in response to prompts, you will usually be transferred to a live person (this exists for rotary phone callers).   Avoid the speakerphone. The health plan's Interactive Voice Response system (IVR) and your speakerphone may not work together. Also, the IVR may interpret background noise (voices, sirens, or a dog barking) as your response. A handset or headset may work better.   Slow down. If you attempt to "work ahead" of the prompts, the Interactive Voice Response system might not recognize your answers. Other Phone Tips Allow enough time for the call. A few minutes between clients is typically not enough to unsnarl a claim problem or to check coverage. Running out of time and having to call back will only add to your frustration.   Be ready. Be ready to give your SSN or EIN (Employer Identification Number) and your NPI (National Provider Identifier), if you have one. Also, to allow access to a confidential client file, the plan rep will ask you for at least two pieces of information about the client, such as her social security number (SSN) or insurance plan ID, and date of birth. Have all relevant documents handy.   Avoid leaving messages. Many plans aren't good at returning calls, and speaking to a live person is always preferable. But if you must leave a message, leave as much identifying information as possible about the client and the issue. Speak slowly and clearly, repeating all numbers and spelling out all names.   Don't take the 'fax back' option. Avoid their offer to fax you a summary of the client's benefits. The answers you need are typically not in these summaries. Also, they may only contain medical coverage information, not mental health, so they can be misleading.   Keep a record of the call. Most plans document all calls, and may even tape record them, which can be helpful if you later need proof they gave you incorrect information. Document the name and the direct phone number of each person you speak to, the date, and exactly what you were told.   Or forgo the phone altogether. While I HIGHLY recommend you call when initially checking insurance benefits, some info can be found at the plan's Web site (ex. claim status, authorization confirmation, etc.). Want more great tips like these? Get the must-have manual every therapist should have. Order now! Just click here [ back to top ] A Program That WANTS to Help Your Clients Pay for Your Services? By Barbara Griswold, LMFT (August 15, 2008) We have all seen clients who have been molested, raped, physically abused, or who have been the victims of domestic violence. You probably have also seen a sibling, parent, or partner of someone who has been victimized. But did you know that there is a program that actually WANTS to reimburse you for your sessions with these clients? The Victim Compensation Program (VCP) — sometimes also known as "Victim/Witness" — is a California government program that may help victims and their families pay for crime-related expenses. Benefits include crime-related mental health, medical, and dental treatment. The list of covered crimes is quite extensive, including murder, robbery, physical and sexual assault, neglect, domestic violence, and injuries incurred from a vehicle when the driver is drunk or flees the scene. Some of us have never heard of this great program, or know little about it. Even worse, many of us have avoided working with the VCP due to our colleague's complaints about slow payment and low reimbursement rates. But VCP has worked hard to change. Many therapists now rave about the program's speedy payments and new reimbursement rates — up to $90/session for LMFTs and LCSWs, $110/session for psychologists, and $130/session for psychiatrists. And get this: You don't have to be a Program provider or sign a contract to be reimbursed. In fact, registered MFT interns and social work associates can be reimbursed! They are even reimbursed at the rate allowed for their supervisor.   Program representatives have stated that claims are rarely denied.   While clients are encouraged to apply for the Program within a year of the date of crime, there are acceptable reasons for late application. This means the crime could have taken place yesterday or years ago.   Those who have witnessed crimes are also covered, including children who have witnessed domestic violence.   Undocumented immigrants also may be covered. In fact, a client is eligible for the VCP as long as he/she is a resident of California (and the crime took place in another state), or the crime took place in California.   If a client has insurance, the VCP may reimburse the client for the portion of the session cost that the insurance plan did not pay. Amazing, huh? Like insurance plans, claims must be filed using the revised CMS/HCFA-1500 claim form. (To order these forms, click here.) Many clients (and therapists) aren't aware of this wonderful plan. I know I have seen hundreds of clients who could have benefitted from this program. My ignorance has done these clients a terrible disservice. Look into this — for the sake of your clients. California therapists can visit the Victim Compensation and Government Claims Board (VCGCB) web site at www.vcgcb.ca.gov for general information about the VCP and for the contact number to the Victim/Witness Center in your own county. Out-of-state providers should check their state and county government web sites for similar programs. [ back to top ] The New PTSD: Pissed at Those Stupid Deductibles By Barbara Griswold, LMFT (June 16, 2008) Deductibles may be the most confusing, annoying, and disruptive part of working with any client who seeks reimbursement from their insurance. So even if you have never signed a contract with an insurance plan, this is stuff EVERY therapist should know. What's a deductible? This is the amount that a client with insurance has to pay out-of-pocket before the plan pays a dime. Do all plans have deductibles? Thankfully, no. This is more common if a client sees an out-of-network therapist (one who has NOT signed a contract with the health plan), but many plans have a deductible for all providers. What's changed? In the olden days, deductibles were usually $100, maybe $250 at the most. But lately I have seen clients with $1000, $3000, even an $8000 deductible. No kidding. This coverage is great if you get hit by a bus, but not so great if you have a garden-variety mental or physical illness. Why the increase? Health plans are not making the huge profits they used to enjoy, so have developed this way to shift the high cost of health care to their members. Coupled with ever-increasing premiums and larger copayments (often $30 or $40), therapy is becoming much more expensive for clients with insurance. Why is this so important? Let's look at an example. You are a contracted provider with the client's health plan, which pays you $60 per session. Your client pays her $20 copayment at each session. At the end of the month, you submit a claim. When the Explanation of Benefits (EOB) arrives six weeks later, you get no payment because the client has a deductible of $600. Now ten weeks into treatment, you turn to your client to pay the $400 balance (remember she paid $20 at each session). At the very least your client may be ticked off. Even worse, your client may not be able to pay you, and may drop out of treatment. Worse yet, your client may have already ended treatment in the ninth session, making it harder to collect. What if my client pays in full when she comes? Let's say she submits the bill to her insurance plan, and finds out when the claim is processed that the plan won't reimburse her because of the deductible. She may have counted on this reimbursement when choosing to see you. So she might be annoyed that you didn't give her this important information ahead of time. And if she isn't going to be reimbursed, she may be unable to continue treatment. There's more. Let's return to the example above. As a preferred provider, the plan will only count your $60 contracted rate toward the deductible — you cannot charge more for any session you have with this client. If your client has a $600 deductible, the plan will not start paying until the 11th session. Let's say you are NOT a contracted provider with the plan. In our example, you charge $125, but the plan caps its reimbursement at $80 per session for an out-of-network provider. Due to your client's $600 deductible and this $80 cap, she will not be reimbursed at all until the seventh session. Starting at the eighth session, her plan won't reimburse her for $20 of each session (this is her copayment, the client's portion of the bill) AND won't reimburse the $45 difference between the $125 she paid you and the plan's $80 cap. Final tally? Of the $125 she paid you for the session, she will not be reimbursed for $65 of her payment, or more than half. There's even more. One of my clients has an employer who has chosen a less expensive Blue Cross plan, which pays a maximum of $25 for each session. This means that only $25 is applied to the $600 deductible for each session. This means if your contract rate with Blue Cross is $67, your client will have to pay $67 out-of-pocket until the deductible is used up in the 25th session. After that, her copayment will be $42. Just to make this more annoying, some plans have one deductible that applies to any of the client's medical or mental health visits. But some have a separate mental health deductible, which may be split between you and any psychiatrist or other therapist (e.g. a couples therapist) that the client is seeing. This means the client's visits to medical doctors may not reduce their mental health deductible. One final complication: The deductible usually starts again at the end of the calendar year. This means when your client finally uses up her deductible, the whole out-of-pocket dance will start again in January. Have I completely confused you yet? Have I completely confused you yet? My advice? Remember that even if you've never signed a contract with an insurance plan, this deductible stuff applies to your clients, too. This is one reason I STRONGLY advise ALL therapists to check coverage after the first session. In fact, I often get insurance information on the first phone call, telling my client that I want to be sure there are no surprises for them down the line. After this call, I'll be able to inform a client if there will be no reimbursement for the first session(s). Then your client can decide if she can afford treatment — and you won't be stuck trying to collect for an unpaid session. You will need to ask the plan numerous questions, including whether the client has a deductible, how much it is, whether the deductible varies by diagnosis, how much of the year's deductible has been used, and if this deductible is for mental health only. In my book, Navigating the Insurance Maze, I've included a helpful worksheet outlining 6 questions you should ask clients about their plan, and 12 essential questions to ask the plan when checking coverage. I also explain why you should never trust what the client or her health card says about her coverage. To learn more about handling insurance issues like this that EVERY therapist should know, check out my book Navigating the Insurance Maze: A Therapist's Complete Guide to Working with Insurance – And Whether You Should — just click here — or to order the book, click here. [ back to top ] Barbara Griswold, LMFT, is the author of Navigating the Insurance Maze: The Therapist’s Complete Guide to Working with Insurance — And Whether You Should. E-mail barbgris@aol.com, visit her Website at www.navigatingtheinsurancemaze.com, or call 408.985.0846 to purchase the book or the new forms, to find out about upcoming workshops, or to get answers to your insurance questions. Copyright 2008-2009, Barbara Griswold, LMFT. No part may be reproduced without written permission of the author. TO ORDER the new forms and specially-designed CMS-1500 envelopes, click here [ back to top ] TO RECEIVE BARBARA'S FREE MONTHLY INSURANCE E-MAIL NEWSLETTER, CLICK HERE (Your information will remain confidential.)