Insurance panel credentialing question

[greyish815]

Hello everyone,

Wondering if any of the licensed people on this thread can shed some light on this topic.

I am a doctoral candidate in clinical psychology and I also have my LPC. I was a master's level clinician before pursuing my doctoral studies (but have not yet gone through the insurance credentialing process--I know it is a nightmare). I am in my final year, working at my APA-accredited internship, my dissertation is completed, etc.

I am looking to get credentialed with insurance panels at the LPC level in order to see some clients in private practice next year and into my post-doc year while I am working on licensure as a psychologist. I know this process takes a while, and my plan is to be on insurance panels by next spring. Anyway, my question is this: if I get on panels as an LPC, might I have a difficult time switching over my license with the insurance companies as a psychologist once I obtain that licensure? Given the nature of insurance companies, my fear is that they might give me a hard time because they may want to pay me the lowest amount possible, and not want to reimburse me at the level of a psychologist. I have no idea if this is a legit concern or not, it's just something that crossed my mind.

Any insight would be helpful. Of course I worked really hard to become a future psychologist and I want to be reimbursed accordingly. There is no comparison to what I knew as a clinician at the master's level versus at the soon-to-be doctoral level (not to mention my experience and skill in psychological assessment), and when I get licensed as a psychologist I should be reimbursed for that level of expertise.

Thank you for the help!

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[AcronymAllergy]

I don't know that you'd run into any significant problems, but folks who've gone through the insurance paneling process can speak to that more than me.

I just wanted to raise one point to keep in mind: if you're seeing folks and billing them as an LPC, it might thereby be difficult to convince a licensing board (and/or they may have policies against it) that those hours would count as doctoral-level supervised practice. Thus, you may need to decide prior to seeing a patient (perhaps based on what you'll be doing with them) if you want them to "count" toward doctoral supervision, and as such, you may not want to bill through your LPC license. That, or you may just need to have a psychologist supervising/signing off on that work, although that in turn may disqualify it as being billing-eligible for the insurance company. No clue.

No idea if that's a valid concern, either, but I'd say it's certainly worth checking with your state psych board.

 

[greyish815]

Yes, I appreciate that thought. My plan was more to see some clients on the side in the evenings, in addition to a full-time post-doctoral type job that counts toward licensing hours, if that makes sense. I've had some requests that I join group practices, and it would be really nice to have a foot in the door somewhere while I work on my licensure elsewhere, to ease with the transition into private practice work. But I wasn't thinking that these hours would necessarily count toward licensure as a psychologist.

But that's good to keep in mind, in general.

 

[Doctor Eliza]

I was thinking along the lines of AA, but also not sure how it would work with the obligation to take insurance. If you are seeing a client with X insurance, you are required to accept that insurance from them if you have a contract with the insurance provider. So what if your client with X insurance comes to you during the day when you have your psychologist hat on. You cannot turn them away saying that you are not paneled with X insurance because you are paneled as a mental health provider with X insurance. I'd think you'd have to see them as an LPC and take their insurance. You'd have to limit your daytime practice to people who don't have the insurance you accept as an LPC.

Of course, check with the insurers, but I think that might be an issue.

 

[AcronymAllergy]

Yes, I appreciate that thought. My plan was more to see some clients on the side in the evenings, in addition to a full-time post-doctoral type job that counts toward licensing hours, if that makes sense. I've had some requests that I join group practices, and it would be really nice to have a foot in the door somewhere while I work on my licensure elsewhere, to ease with the transition into private practice work. But I wasn't thinking that these hours would necessarily count toward licensure as a psychologist.

But that's good to keep in mind, in general.

Yep, definitely makes sense, and that was exactly the type of setup that popped into my head as a way of avoiding any snags with the licensing board.

 

[smalltownpsych]

I would also make sure that you are clear on your title, as well. I don't know what they call a post-doc in your state it is Psychological Resident in mine, but you want to make sure that title is not connected to anything you are doing in your private practice, i.e., business cards, signage, documents, etc.

 

[smalltownpsych]

Oh and I doubt that the insurance companies will care much when you get your license as a psychologist, just let them know. You might not even have to re-apply. You would probably need to change your NPI taxonomy, too.

 

[Therapist4Chnge]

I was thinking along the lines of AA, but also not sure how it would work with the obligation to take insurance.

It will be clear in the provider contract about how you are credentialed with the insurance panel. The contract should outline at what level (LPC, LP, etc) and what fee schedule and associated plans within that insurance company's different offerings. The how is important because you are seeing them as an LPC, not as a post-doc / psychology trainee. The ethic obligations need to be outlined to ensure presentation of credentials is accurate for the treatment being sought. "I am a counselor…" etc. The only potential stumbling block I see (far from all inclusive, not legal or professional advice, etc) is making sure your hours are kept separate, so seeing pts under your LPC should be done outside of your hours of your post-doc, in a different office, etc.

 

[PsyDr]

I bet that would screw up your NPI designation. I don't think you can have two.

 

[smalltownpsych]

I bet that would screw up your NPI designation. I don't think you can have two.

I was referring to changing it after attaining license as psychologist. I would assume current taxonomy reflects the LPC license. I know mine was changed from student status to licensed status, but my employer at the time was the one who did that for me so not sure what is involved.

 

[R. Matey]

I bet that would screw up your NPI designation. I don't think you can have two.

Not necessarily. You can change your NPI taxonomy without having to apply for a new number. Here's the website:

https://nppes.cms.hhs.gov/NPPES/Help.do?topic=Taxonomy

 

[R. Matey]

grayish815, I'm in a similar position to you, though I'm a few years behind you. Would you mind if I PM you about your experience?

 

[AcronymAllergy]

Not necessarily. You can change your NPI taxonomy without having to apply for a new number. Here's the website:

https://nppes.cms.hhs.gov/NPPES/Help.do?topic=Taxonomy

I think PSYDR might've been referring to the fact that greyish would be functioning in two different clinical roles (i.e., LPC vs. psychology postdoc)

 

[R. Matey]

Ah. I see. That makes more sense.

 

[greyish815]

Thanks for the thoughts.

To be clear, the private practice work would definitely be separate from my post-doc work and hours. I don't think it would be difficult to keep them separate.

Also, I completely understand the ethical implications and would never misrepresent myself to clients or at the job, etc. I am hyper alert when it comes to ethical stuff

Dr Eliza-- that's all good stuff to consider. I appreciate the thoughts. I guess it could get tricky depending on where I do my post-doc hours...?

Thanks for thoughts. And yes r matey feel free to PM me but I'm not on here much so sorry if slow to respond!

 

[AZ Credentialing]

Ok to answer your question it really depends on the insurance company. You will go through the credentialing process as an LPC and be participating as such until you complete your advanced degree. At the time you achieve your advanced degree, you will simply need to contact the insurance company and let them know you have obtained your advanced degree and will therefore be changing your primary specialty. Your will probably have to submit a provider demographic change form, the insurance company will have to verify your degree, and then the loading process of changing the information in the claims system can take 30-45 days(generally) depending on the insurance company. This isn't to say all insurance companies work this way, but generally most ins. companies will have this process or something similar. Takes some time to change over but you shouldn't get a hard time from them or resistance as you're simply advancing your education and scope of practice. Insurance companies do not have a problem with this, unless they do not contract with providers in a particular field of practice.