Hi, my name is Shauna Garrett and I am the owner of Psychotherapy Billing Systems, a billing service dedicated to the needs of mental health professionals. I am starting this blog because I feel that I have so much information to share with therapists about insurance billing and general practice management. I hope you learn something that can help your practice.
This is a great place to start and will be the topic of my first post. If you choose not to use a billing service I am still going to share lots of things that are going to help you smooth out the administration of your private practice.
A billing service can greatly reduce your administrative burdens. If you choose to do your own billing, I want to walk you through some of the things you need to know.
First…..know what insurance panels you are on. If any. You will have to choose whether to contract with private insurance. There are benefits both ways.
*If you choose to be in network with a health insurance, the benefit for you is they will send you patients. You will show up in their directory and you can accept their patients but you will have to accept their “in network” rate which will include a discount or write off. As an example, for Anthem Blue Cross of California, if you are a LMFT, you can expect to receive $66.00 (approximately, rates vary) for your 90834 session. If you bill them $150.00 or $300.00 you will still receive $66.00 and write of the rest. If the patient has a $20.00 copayment, you will receive $46.00 from the insurance and $20.00 from the patient. The benefit to this arrangement is Anthem BC of California has lots and lots of patients. If you get on their panel you will have a large pool of patients to see.
*If you choose to be out of network with health insurance, the benefit is you can charge what you like. For example, you can set your fee as $200.00 per session and if the patient has insurance you can go ahead and bill the insurance for out of network benefits. The insurance may pay $50.00 and the patient would pay the remaining $150.00. Word of caution here, you should collect up front until you determine that the insurance will definitely be paying for services and that the check will come to you. Some insurance companies will pay the patient directly for out of network claims. Not everyone will have out of network benefits. If a patient has an HMO or EPO or a variety of others there is no out of network. Generally out of network benefits have a larger deductible and larger copayment for the patient. If you choose to go this route, you can collect your fees up front and give your patient a “superbill” which they can submit to their own insurance and you do not have to worry about any billing. The downside to this is that your pool of patients will be very small. Most people pay for their insurance benefits and want to use them. If they have insurance often they will want to use their insurance plans providers.
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