Learn “Insurance-Speak” So You Can Get the Information You Need to Treat Your Clients
By Deb Legge, PhD CRC LMHC
If you are new to private practice, the whole idea of dealing with insurance companies can be intimidating. Most clients are not aware of their benefits, and even if they are, it’s always good for you to verify the information before you begin working together.
First, collect some key information:
Private Practice can be an
exciting and rewarding option
for counselors. Getting the information and support you need, can help you to build a
successful and sustainable
private practice. Visit www.InfluentialTherapist.com
for more helpful information
on starting and growing a
private practice, and
to submit your questions
and ideas for future articles
in the Advocate.
- Your client’s full name (as it appears on their insurance ID card),
- The insurance ID number with suffix (if one exists),
- The client’s date of birth, and
- The contact number for behavioral health (or customer service) on the back of the insurance card.
Next, put together a list of questions.
You’ll use these questions when you call an insurance company to verify your client’s insurance coverage and benefits. Feel free to use my “cheat sheet”—I hope it comes in handy!
- What is the effective date of the coverage, and is the policy still in effect?
- Is the policy benefit based on a calendar year? If not, when is the anniversary?
- What is the client’s benefit for outpatient mental health?
a. (If unknown) Am I considered an in-network provider for this plan?
i. If not, is there out-of-network coverage?
b. Regarding the benefit, is there a deductible?
i. Has any of it been met yet?
c. Are there co-pays and/or co-insurance?
d. Is a pre-authorization necessary?
i. (If yes) How do I obtain it?
e. How many visits are allowed at this time?
f. How many visits are allowed each year?
g. What is the procedure for obtaining more sessions (if needed)?
- What are the options for billing (paper, online)?
- Are any special forms required? (Some EAP companies require you to use their billing forms; some insurance companies require session notes with each invoice.)
- What is the billing address for claims?
- What is the phone number for the claims department?
This effort takes just a few minutes. It’s a good investment of your time to be sure that you are doing things correctly from the start, and it will likely speed up your billing and collections.
It’s your money—make it your priority!
Visit AMHCA's Private Practice Library
Getting the information and support you need on “The Business of Private Practice” can help you to build a successful and sustainable business. Visit the AMHCA Member Library for additional articles by Deborah Legge, PhD, CRC, LMHC—for members only—on the business of running a clinical mental health counseling practice.
- “Billing for Your Services” (October)
- “Getting Started, Going Solo” (September)
- “Policies and Procedures for Private Practice” (August)
- “Marketing Your Private Practice” (July)
- “Private Practice Website Tips” (June)
- “Finding a Home for Your Private Practice” (May)
- “Setting Your Fees” (April)
- “Getting on Insurance Panels” (March)
- “Finding Your Niche” (February)
- “Is Private Practice Really for You?” (January)