As a Licensed Professional Counselor, I have worked in a variety of settings, including, believe it or not, the infamous managed care organizations. In fact, I have worked as a Utilization Reviewer for 3 major insurance companies. As such, I have a unique perspective and insight into the pros and cons of accepting insurance. Moreover, as a CEO of my own private practice, Ascent Psychotherapy Center, I accept numerous private and public sector insurances (i.e., Medicaid).
Nevertheless, I'd like to focus today's blog post on the common misconceptions or myths associated with accepting insurance. I write this as a way to offer a different, albeit unpopular view regarding accepting and getting on insurance panels.
Myth #1: Insurance reimbursements take too long.
While this can be true in some instances, I have found that the majority of insurance companies reimburse fairly quickly, within 5 business days. Albeit you don't get paid immediately (as you do in private pay), 5 business days is not an unreasonable amount of time to receive payment.
Myth #2: Insurance companies requirements are too strict.
This really depends on how one defines "strict." If you mean does insurance companies require evidenced based practices, have a policy on how many sessions one can attend, and require that you maintain license and insurance, then yes, they are strict. I believe, however, that many licensed clinicians already adhere to these same guidelines. Moreover, many licensed clinicians have an ethical code that guides how we conduct therapy. In particular, Texas LPC Code of Ethics indicates that if therapy is not producing any results (i.e., benefiting from the counseling relationship), then we are to terminate sessions and refer. Many insurance companies, even public sector insurance, allows for maximum of 30 sessions per calendar year, after which, if additional sessions are needed, then you simply provide information to support necessity for continued care. And many clinicians also believe in using therapeutic modalities and treatment that are evidenced based.
Myth #3: It takes too long to get on insurance panels.
It can feel like you are in a hospital waiting room yourself. This also depends on the insurance company. Becoming credentialed with EAP insurance companies are much faster and require less paperwork in general than do managed care organizations (major insurance providers). Texas Medicaid is also relatively quick in comparison to the bigger insurance companies. As such, you can typically become credentialed with EAP insurance providers within one month as well as Texas Medicaid (I am not familiar with Medicare). The larger insurance companies can take up to 6 months, but I believe this process is longer due to ObamaCare and the Open Access Health Market.
Myth #4: Submitting claims is time consuming.
In my experience, it only takes me 2 minutes, max, to submit a claim for a client. Some claims I can submit in less than one minute. The same time it takes for you to invoice a client or accept payment is nearly the same amount of time to submit a claim. Many insurance companies have an EDI or Clearinghouse that you can use free of charge. You can submit all of your claims individually or in a batch at the end of the day. It is not as cumbersome as one may think. And you can track when your payment has been sent and all managed care organizations, including Medicaid, offer EFT.
Myth #5: Insurance companies are notorious micro managers.
Insurance companies were created to manage care due to past history of fraud, waste, and abuse. As such, they only exist in order to ensure that fraud, waste, and abuse are NOT occurring. It is rare that your client's files will be audited or requested. Only in cases where medical necessity is called into question, additional sessions are requested beyond the 30 day per year limit, and/or concerns regarding fraud/waste/abuse are an issue, they may request to review your client's files. There are other instances where files are review able, such as client requesting short-term disability, court/legal matters, etc. By and large, though, insurance companies do not micromanage providers.
In closing, with Obama Care, everyone has to have health insurance and those who pay for their health insurance would like to use their benefits that they are paying for to access care. The same way we, as individuals who also carry insurance, would like to use our insurance to pay for health care. Perhaps by uncovering and refuting some common myths associated with accepting insurance, clinicians will be more open to accepting both private pay and insurance pay clients. There is always the option of limiting the number of insurance panels you want to be credentialed with and this can allow for greater access to care for those who would otherwise not be able to afford it.