Accepting Insurance and Third-Party Payors In Your Private Practice | TPOT 204

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By Gordon Brewer, MEd, LMFT, Gordon Brewer, and LMFT: Therapist | Consultant | Writer | Speaker. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.

In this episode, I talk about some of the myths and misperceptions people have about being on insurance panels. I delve into this topic and let you know what I've learned about it from my insurance-based practice. First, I speak about the stigma around accepting insurance in private practice. If you accept insurance, you are just as valid and can be just as successful as private practice owners who are cash-based. Tune in as talk about the pros and cons of insurance panels, why I chose to be insurance-based, and where to start when you decide to accept insurance.

The Stigma Around Accepting Insurance In Private Practice

Many people are curious about accepting insurance and if they should or not. There is no correct answer. If you start to delve into your mindset and think about it all, it might just be something that you should consider doing. When you look at all that is out there, there are so many great resources around building a private practice. It seems like most people are encouraging cash-pay. There seems to be a little bit of a stigma against having an insurance-based practice. Many people say that you don't want to be controlled by insurance companies. If therapists don't have a cash-based practice, they're second-class citizens for being an insurance-based practice. I don't agree with that at all! In fact, my success comes from being insurance-based.

The Pros and Cons of Being An Insurance-Based Practice

There are a lot of pros and cons to being on insurance panels. Certainly, one of the cons of being insurance-based is that you've got to have more systems and processes in place. You've got to do more work on the front end to get prepared for insurance. You need specific systems when you start accepting third-party payors and being reimbursed by insurance companies for your services. The biggest con is that there is some work on the front end of being insurance-based.

The pros for being insurance-based are that you've got a built-in referral source by being on insurance panels. I would say at least half the people that we find are from their insurance. In other words, they checked with their insurance provider first to see who would accept their insurance in the area. When making an appointment with us, people ask, how much does it cost? Plus, they ask if we accept insurance. That's why I wanted to be an insurance-based practice. People depend on their insurance, and I want to help those people.

Ready To Accept Insurance? What To Do First

Where do you start? Research your area to find out which are which insurance panels are the most prevalent. In my area, most people have Blue Cross Blue Shield health insurance. Another thing to research is looking at significant employers in the area. Then, check which insurance those companies use. Next, use that data to decide which insurance companies you want to be paneled with. Another thing to note is that when an insurance company offers you a contract, that's negotiable! Make sure to negotiate what rate you will accept.

Systems and Processes Around Filing Insurance Claims

Figure out your systems and your processes around filing insurance claims. If you're on insurance panels, you need a traditional way to send claims off. The best way I know to do that is through an electronic health record system. TherapyNotes helps my practice with this. It's a few clicks of a button to get your insurance claims sent to the insurance companies to be reimbursed. For the most part, insurance companies have a pretty quick turnaround for electronic health claim submissions. Within a week of sending off the claim, we are getting paid. There's a myth that you have to wait a long time to get paid from insurance companies – that's not true! So, make sure you have a way to submit claims and make it as automated as possible.

Cash-Based and Insurance-Based Private Practices

If you're not ready to be entirely reliant on insurance, there's a hybrid option! You can have a mix of cash-paying clients and clients that use insurance. Give people a choice on whether or not they want to pay for therapy through a third-party payor. Remember to set your full fee at a reasonable place; your fee needs to be your FULL fee. The insurance company will pay you what they pay you. Then, you write off the difference between the full fee and the contract rate. If they choose not to use insurance, you can offer a sliding scale based on family income. We don't go and check their income; instead, we go on the honor system. Ensure that the lowest rate on your sliding scale fee schedule is in the ballpark of your average reimbursement rate from insurance companies. If you want more tips about deciding to panel with 3rd-party payors, check out this FREE webinar coming up: https://practiceoftherapy.com/insurancepractice.

Being transparent… Some of the resources below use affiliate links which simply means we receive a commission if you purchase using the links, at no extra cost to you. Thanks for using the links!

Resources

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Gordon is the person behind The Practice of Therapy Podcast & Blog. He is also President and Founder of Kingsport Counseling Associates, PLLC. He is a therapist, consultant, business mentor, trainer, and writer. PLEASE Subscribe to The Practice of Therapy Podcast wherever you listen to it. Follow us on Twitter @therapistlearn, and Pinterest, “Like” us on Facebook.

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