Weighing the Pros & Cons of Taking Insurance?

All You Need to Know to Decide if Mental Health Billing is for You

Guest post by Kym Tolson, LCSW, CSAC

Have you thought about taking insurance in your private practice, but then give up because you are afraid, nervous, or overwhelmed?

Or maybe you’re worried that you don’t have enough time to bill insurance and see clients?

First, let’s talk about the 6 benefits of taking insurance in your private practice.

Some of the main reasons to think about accepting insurance for therapy, are that it will give you more freedom, flexibility, and financial security.

PROS: 6 of the Biggest Benefits of Billing Insurance

1. Get Access to a Huge Pool of Potential Clients
   Once you get paneled with insurance companies, they will add you to a referral network that sends a steady stream of clients your way. 30-50% of therapists are running their own practices, billing insurance, and enjoying schedule flexibility, according to the above article.
2. You Attract More Clients When You Accept Insurance
   Not only do you get a bigger pool of clients when you take insurance, but your existing clients will be able to come more often due to lower copays. Accepting insurance gives you more consistent work because it allows clients to increase the number of sessions they do from bi-weekly to weekly, etc. Imagine going from paying $100 per session to $20, and you can see what a difference it could make to your client base.According to a report done by the U.S. Dept. of Health and Human Development mentioned in this article, less than half of the 45 million adults suffering from mental health problems see a therapist. The number one reason is they just can’t afford it, with or without insurance. Taking insurance gives more people who need it the chance to get help.
3. Greater Financial Security Due to Predictable Payments
   The payment schedules for insurance companies are fast and predictable. The benefit is that you know exactly what you get paid and when, and that gives you financial security and stability.
4. Save Time & Money Marketing Your Business
   Once you are on a panel, the insurance company will advertise you on their website. Yes, you heard that right — free marketing! Save time and money on advertising costs, because the insurance companies do it for you. If you hate this part of running your business, you will love taking insurance.
5. Get More Clients in Your Targeted Specialty or Niche
   Insurance companies will ask you to set a specialty area you want to work in, and then send potential clients your way based on this niche. I now refer the clients outside my specialty to other providers, so I get to focus on the niche I most enjoy.
6. Keep Clients For the Long Term
   Thanks to lower copays, clients will be able to stick around longer too. Most people are looking for therapists that take their insurance. However, therapists are the least likely of all health providers to take insurance.

CONS: Issues to Be Aware of When Taking Insurance

1. Time to File Claims & Deal With Insurance-Related Items
   Estimate an extra 30 to 60 minutes per week, on a good week, to process claims. If there is a denied claim, definitely expect to spend more time.
2. Insurance Companies Can Be Picky About Who They Allow On Panels
   This can cause some frustration, but by networking with other providers in your area, you can see which insurance panels are most likely to accept you. To start, ask therapists in similar specialties who they panel with. Also, you can call provider relations for a particular company and ask if they are accepting new clinicians in your area.
3. Your Rate is Dictated by the Insurance Company
   This can be a big drawback for some therapists, as the payout rate may be lower than what you normally charge. You may have to see more clients as a result, but the source of clients is limitless.
4. Credentialing Applications Require Patience & Take Time
   This is a somewhat complicated process and is often the most frustrating part of getting started with accepting insurance. The good news is you only have to do it once.
5. Getting Someone on the Phone from the Insurance Company Can Be Challenging
   It can be difficult to get an actual person on the phone, and sometimes it takes multiple phone calls to resolve claim issues. I keep a spreadsheet of everyone I speak with at the insurance companies, just in case I need a contact person down the road.

Biggest Fears Therapists Have About Billing Insurance on Their Own

What if I Mess Something Up?

This is a huge concern for people. My advice to prevent this is to use an EHR. Generally, if you’re using an EHR (Electronic Health Record) it’s almost impossible to mess billing up.

Insurance companies will not let the claim go through if there is an error, so it is a fail-proof system. The other thing you can do is educate yourself. The more you know upfront, the less likely you are to make mistakes.

Once you get past the learning curve, you will find it super easy to file insurance claims.

What If They Try to Take My Money Back? 

Generally, if you take some steps at the beginning of the process, you won’t have many problems with the insurance companies trying to take your money back.

Tips to Prevent Recoupments:

1. Top Tip: Verify Benefits before you see the client. 
2. Be sure you have good policies in place notifying the client that they will be responsible for any unbillable claims that don’t go through. 
3. Educate yourself around the documentation requirements. I keep these details on my spreadsheet as well. 
4. File the claim quickly. This way you will know for sure if the service will be covered or denied sooner rather than later.
5. Next, familiarize yourself with the important aspects of writing an audit-proof progress note. There are a lot of details to pay attention to, but in general, here are a few tips. Make sure you notate what type of session it was, telehealth or face-to-face. If it’s telehealth you need to document the actual location of where the client is located.  You need to put the specific times of the session in as well. 
6. You need to follow medical necessity guidelines for the insurance company and also make sure you’re tying your progress note into your treatment plan. Your treatment plan needs to have measurable and specific goals with time frames that are specified. Email me if you would like an example of a well-written progress note.

Still not sure if taking insurance, or doing mental health billing, is right for you?

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