how to work with insurance as a mental health provider

As a mental health provider, I accepted insurance for most of the years of my career. As a social worker, I fully understand it is an accessibility issue. Many people cannot front the money for therapy and get reimbursed later. Nor can they afford to pay out of pocket. And in a time when insurance is not free anymore (I do remember those golden years when it was) people want to utilize benefits they are paying for.

However, coping with insurance companies as a provider is often a bit of a nightmare. Recently, I had a client with an out-of-state plan. The person worked through all the hopes to get me approved to see them as an out-of-network provider. They told the client they would have a certain percentage co-payment but were unable to tell the client if my entire fee would be paid. Many insurance companies have a reasonable fee that they will not pay beyond. However, they won’t tell you what that amount is. When I tried to verify benefits, I was told I was not in the system. I tried to bill and the error message was my ID numbers did not match. I had the client call and their insurer left me a message saying submit again. When I tried to call the number they left me I was unable to get to customer service. They said, “That is not an option”.

I used a trick I have used before. I went to the Twitter page of the insurer and DM’d them. I got a call within two hours and the agent told me that I had to bill my local Blue Cross plan, not the plan whose name it was. This was a new concept for me and I googled it and found that when you are billing an out-of-state plan over 90% of the time you need to bill your local plan. Of course, there was more than one local plan but I was able to electronically bill both of them. One of them allowed me to process an eligibility request so I figured that is the one that will pay.

Time spent was over 2 hours. Now I will say had I read the back of the card that was submitted to me it did say submit to local plan. Since historically I had been in network I had never billed an out-of-network plan before so this was new to me. My unreimbursed time spent was about 2 hours. What I took from the experience is that I won’t make exceptions and accept insurance anymore because it is too time-consuming.

This is what has happened to many therapists across the country. Some aren’t in a position to say they won’t accept insurance so they instead spend hours of unreimbursed time trying to get paid. For those of you who accept insurance, I wanted to share the billing information locally and on utilizing social media to get assistance. I have done this numerous times and it has always worked. They seem to have a very competent staff working the social media issues.