Insurance Question

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Night1234

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Hello:

Was just wondering how psychologists / therapists accept insurance. How can a therapist have the ability to accept insurance. Is there a special procedure?

Thanks

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Once a therapist (masters or doctoral level) is licensed to practice independently, they may apply to different managed care organizations to be credentialed as part of the panel (be "in-network"). Generally it involves contacting the provider relations department for the insurance companies in that provider's area.

Credentialing is a pretty tedious process. With the advent of CAQH, it's gotten better in that many companies may use their database. However, for some a paper application is still required and those are in the vicinity of 20 pages long. For each company. Included in your application is proof of licensure, proof of education, proof of having your own malpractice insurance, a request for professional references, and a questionaire about previous professoinal disciplinary action and fitness to practice.

If/when the therapist is accepted onto the panel, they sign a contract agreeing to accept the rate set forth by the insurance company for the relevant level of licensure. If what they charge is more than what the insurance company pays, as a member of the panel they are not allowed to bill the client for that difference. Once in-network, the insurance companies may give out that provider's name as a referral to its members.

That's it in a nutshell.
 
Thanks so much! very helpful. Do you happen to know, after completing all the designated forms etc that you mentioned, if insurance companies easily accept or regect people.

In addition, this is a different question than the original post (i was reading some of your responses to other posts) and just wanted to ask

Why would someone elect to supervise a therapist? is that a requirement that has to be achieved to gain something? Also, what does it exactly mean to be supervised (i read somewhere it can entail an hour a week, etc) so is it just "touching base" with the supervisor.

Thanks!
 
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To answer your first question, it's completely variable on the company and their current needs. Some may need providers of any kind, others may only need psychiatrists and say that they are "full" for masters and/or doctoral level providers. On occasion, even if they're "full", someone with a true specialized niche (ie gambling treatment, eating disorders) may be able to get on if they can plead a good enough case.

As far as supervision, LPCs and LCSWs typically do not supervise therapists, they supervise MAs and MSWs as they learn to become therapists. There's a big difference. It's a mandatory requirement of every licensing board that license-eligible practitioners receive a certain amount of clinical supervision. What is done will vary based on the supervisee's job description, but generally there should be oversight of and responsiblity for their clinical work, continuing their clinical education, assessing their strengths and weaknesses as practitioners and addressing those issues that could interfere with their ability to practice ethically and effectively.

As to why someone would supervise, I can only speculate that for most it's a recognition of the importance of quality education and training in [insert field] in order to promote that field. Beyond that, some may do it for the above reason and because they can charge for it, and others who are agency-based may be told by their supervisors that they'll be doing it.
 
ahhh very insightful! thanks so much

about insurance - i realize this was mentioned before - but it is a real shame that the health industry is dictated by insurance companies!!!

thanks again!
 
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