After seven years, I’ve decided to call it quits with insurance. I’ve had the thought many times over the years, but until now haven’t actually taken action. This time I’ve alerted clients and written my termination letter to Aetna and Blue Shield, but not without some hesitation and nervousness.
You see, when I was first licensed in 2010 I knew marketing was not my strong suit. I’d heard the horror stories about piles of insurance paperwork and sessions left unpaid. But, I wanted to be in private practice and without knowing much about how to market myself I figured that I could quickly gain clients without much effort and then gradually cut back on taking insurance clients. That’s more or less how it worked. My practice owes its beginning to those first clients from Aetna, but it hasn’t been so easy to let go.
Hopefully, my experience can help you, or at least save you a little time, if you’re considering entering the insurance game.
First off, get a National Provider Identification number (or NPI). You won’t be able to apply to be on an insurance panel without it, but luckily this process is fairly straightforward and can be done online.
Next, determine which insurance companies you’d like to be contracted with. This might depend on their reimbursement rates, need for providers in your zip code, or your personal preference. You’ll need to fill out a short application (usually online) to determine if they need providers in your areas of expertise, and zip code.
At this point, it’s important to note that many companies have particular need for therapists who specialize in substance abuse and trauma. You don’t necessarily need to consider yourself an “expert” in these areas to call them a specialty, but you do need to be familiar with that type of work and be willing to seek further training if needed. Agreeing to work with those populations will often help you get your foot in the door.
If the insurance provider determines that you’re a fit for their needs you will be invited to complete the application process. This might be directly through them (like Blue Shield), or through a third party (as is the case with Aetna). Either way, be prepared with your resume, educational information and references. It is a bit of a time consuming process.
I had to wait about three months to have my application accepted and have potential clients referred to me. Taking on these clients was beneficial to me in several ways. First, it did help me accrue a good number of clients in a relatively short period of time so that my private practice was a viable business. Another benefit, that I hadn’t necessarily expected, was that it provided me with a broader range of clients than what I might otherwise have had access to. You see, if they only need to worry about paying a $20 copay, going to therapy is suddenly a much more attractive option for some people. Many of my insurance clients had never had any previous experience with therapy and were working “blue collar” jobs – both things that are generally not true of my non-insurance clients. It’s particularly rewarding to work with people who aren’t as familiar with the idea of self-improvement, and who genuinely seem to appreciate this perk of their employment. I’ve been grateful for the diversity in my practice that insurance has afforded me.
Now for the down sides. As I’m sure you’re aware, you’re going to be paid substantially less than your regular fee. I’ll be forthright here; $67 per 45-50 minute individual session with Aetna, $66 with Blue Shield, and $76 and $81, respectively, for couples or family sessions. You do get slightly more for the first two sessions by billing them as assessments, and if you see clients for 55-60 minutes, that will also add about $10 for Aetna sessions. Remember though, that the copay your client gives you at the time of the session is not in addition to this number, but will be subtracted from what the insurance provider pays you when you submit the claim.
Speaking of claims, it may take an extra few minutes per client, but it is actually quitestraightforward. You’ll need to be familiar with the Health Insurance Claim Form 1500, as well as CPT codes (relating to the type and length of session), and the ICD-10 codes for diagnosis. And yes, you will have to diagnose anyone with insurance. I generally submit claims for clients after 3-4 sessions, and it usually takes approximately 3-4 weeks to receive payment.
So there’s that part too: payment. Usually it goes through just fine, but occasionally, not so much. It may be that the client actually had to meet a deductible before insurance pays anything, or more often that not, just that the insurance company is jerking you around a bit in an effort to save themselves a few dollars. When they refuse payment of a claim, you will likely spend a good amount of time on the phone with them trying to understand their position and correct whatever imperfection they perceived on the claim form. At which point you’ll resubmit the claim and wait around for another 3-4 weeks to see if it gets paid this time.
Perhaps you’re sensing my frustration here? This was by far the worst part of billing insurance, and ultimately why I’ve chosen to get out of the game. It may not happen a lot, but when it does, I end up spending several frustrating hours of unpaid time only to finally be paid that fraction of my fee. I’ve seen working with insurance as a type of pro-bono service I can provide for clients who wouldn’t otherwise make it in to see me, and that has been very valuable.
I probably haven’t convinced any of you to run out and sign up for insurance, but perhaps my experience will help you if you’ve been considering it. Though not without its headaches and sacrifices, it can be especially helpful if you’re just venturing out into the world of private practice.