Print Posted on 11/06/2017 in How-To

Three Ways You Can Support Clients with Mental Health Insurance

Three Ways You Can Support Clients with Mental Health Insurance

While we give a lot of attention to those clients who are seeking mental health treatment while uninsured, we do recognize that many of the clients that you work with will also have some form of mental health coverage. While this coverage can be an incredible asset to clients, anyone who provides mental health treatment for long enough quickly learns that mental health coverage, even from the best providers, is far from perfect.

Many therapists tend to take a more peripheral approach to client issues with insurance coverage. However, for this community, we recognize that our dedication to affordable counseling may mean adjusting the way we support clients who experience problems with insurance coverage. While these can certainly take time, consider the investment you make in supporting these clients similar to as if you were offering sliding-scale: The time you spend going the extra mile here shouldn’t equate to a greater resource investment that you’d be willing to make based on your ability to reduce fees for other clients circumstantially.

Make sure you’ve made a clear case for medical necessity: We know it all boils down to diagnosis for insurance companies, so make sure that you are doing a thorough assessment at intake and correctly matching the patient’s symptoms and history with a diagnosis. This may seem obvious, but many practitioners still do things like using “common codes” for patients that present with similar treatment concerns – these are easily questioned by insurance companies and could end up requiring additional work for you down the road. If necessary, communicate (after obtaining consent) with the client’s primary care physician to ensure that your diagnosis is informed by other contributing factors.

Consider different billing practices: Some practitioners bill insurance directly and require a co-payment at time of service. Others require that clients seek reimbursement on their own after paying for treatment in full at time of service. Which of these seems more aligned with the goals of affordable counseling? While it certainly can be risky switching to insurance billing, especially if a large portion of your clients use health insurance, this can create an enormous barrier for clients in need of treatment. Even for those clients who have the resources to pay for 3 – 4 sessions, if there are delays in receiving insurance reimbursement, this can create unforeseen gaps in treatment based on their inability to cover more sessions. While waiting on insurance reimbursement can be inconvenient for a therapy practice, this same issue can be debilitating for a client who is required to pay at time of service.

Support clients who have been denied reimbursement: Even with impeccable narratives on diagnosis and medical necessity, claims can still be outright denied. For clients who have already started treatment and owe for several sessions, this can be an incredible stressor. As therapists, we can’t simply be expected to work for free. However, in these circumstances, there are things we can do that still support the principles of affordable counseling. These include things like reducing fees owed based on the client’s ability to pay, offering a payment plan, and referring the client out to a more affordable treatment provider while providing sliding-scale treatment during the gap time.  

Keep in mind – none of the above suggestions should be conducted to the extent that it hurts the viability of your practice. But, by taking small steps and doing what your practice can afford, you can help individual clients tremendously at very little risk to your own practice’s well-being.