Clinical practice and insurance panels..

[CPG80]

Hi: My question is directed to everyone, and, perhaps even more to those individuals currently practicing as a clinical psychologists and on insurance panels or have knowledge of the process. I have a Ph.D. from an APA accredited clinical psychology program. However, I don't have an APA internship because my program didn't support the APPIC process (another story for another time). I have two questions: 1) Do you generally need an APA internship to qualify for insurance panels (because I know some require an APA program credential)? 2) Where might I find collective information regarding states and their licensing requirements (post-doc hours, credentials, ect).

Thanks everyone for the help. Also, I am taking the EPPP in a couple months and will be happy to report back my impressions of the test, my preparation and anything else.
Best,
CPG80

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[QPublic]

Good questions. I have not heard of any licensed psychologists being denied credentialling with an insurance panel because of completing a non-APA accredited internship. While it wouldn't be beyond the realm of possibility, I would think it would be highly unlikely. The lack of an APA-accredited internship can become an issue when applying for certain positions though (such as those in the VA system), but that's a different issue. Since you already completed your internship, it's a moot point.

The safest way to obtain information about licensing requirements/statutes for specific states is to check directly with that state's board. Many people have been mislead by well-intentioned peers.

This page has links for each state's licensing board:
http://www.asppb.org/about/boardContactStatic.aspx"]http://www.asppb.org/about/boardContactStatic.aspx[/URL]

The requirements really do vary widely from state to state.
Best of luck on the EPPP -- it's really not that bad!

 

[CPG80]

Thanks for the thoughtful reply!

Good questions. I have not heard of any licensed psychologists being denied credentialling with an insurance panel because of completing a non-APA accredited internship. While it wouldn't be beyond the realm of possibility, I would think it would be highly unlikely. The lack of an APA-accredited internship can become an issue when applying for certain positions though (such as those in the VA system), but that's a different issue. Since you already completed your internship, it's a moot point.

The safest way to obtain information about licensing requirements/statutes for specific states is to check directly with that state's board. Many people have been mislead by well-intentioned peers.

This page has links for each state's licensing board:
http://www.asppb.org/about/boardContactStatic.aspx"]http://www.asppb.org/about/boardContactStatic.aspx[/URL]

The requirements really do vary widely from state to state.
Best of luck on the EPPP -- it's really not that bad!

 

[PsychologistDoc]

Hello all,
I'm currently at a group practice, where I am on several insurance panels. I am starting on the side in a town about 15 miles aways my own private practice where I would prefer to handle only cash paying clients. May I do this, or will the obligations from the insurance panels follow me within the state?

Thanks in advance for your consideration!

 

[Therapist4Chnge]

Hello all,
I'm currently at a group practice, where I am on several insurance panels. I am starting on the side in a town about 15 miles aways my own private practice where I would prefer to handle only cash paying clients. May I do this, or will the obligations from the insurance panels follow me within the state?

Thanks in advance for your consideration!

Your physical location (within the state) is irrelevant to the insurance companies. If your office was across state lines and the insurance companies didn't have a presence in the other state....dicier. You should consult your provider agreements with each, though I am pretty sure you will not be able to take cash pay from patients who have and choose to utilize their insurance benefits.

I am not a lawyer, so please don't take my post as legal advice, etc.

 

[stigmata]

Insurance companies do not care about APA anything, just whether you have a license. Regardless of insurance participation/panel membership you can always accept cash in lieu of billing. No insurance can prevent you from doing this, with the exception of...you guessed it...the feds and medicaid.

 

[PsychologistDoc]

@Therapist4Chnge
@stigmata

Thank you very much indeed for your replies. Sounds like I should review again my provider agreements, and probably call each one just to be sure. Thanks, this validates my initial thinking, Therapist4Chnge.

stigmata, after conducting this review, if all checks out accordingly it sounds like except for the feds and medicaid, I should be able to:
-take cash at my upcoming private practice from people who have insurance for which I'm paneled,
-but at the group practice (where I am working and will continue to work after opening the private practice) these same insurances for which I'm paneled my group practice will go through the option of accepting their copays/fees from the client and getting reimbursement from insurance companies subsequently.

If this is the case, it would allow me to ramp up my private practice by taking cash at first, and then when I get to a certain point since I'm already paneled I may then start accepting insurance when I get +5 clients weekly. If anyone has any advice on a strategy for such an approach I'd be grateful, and I'll certainly plan on updating everyone regarding what my experience turned out to be! Thanks all.

 

[stigmata]

Yes. What you do is have your patients pay cash for the services rendered. Give them a superbill that states your Dx, and code for the service provided (90801, 90806 etc..). They use the superbill to get reimbursed directly from the insurance. This is also a good way to as you are then not required to release additional clinical info to the insurance company as you would if you billed directly for your services.

 

[PsychologistDoc]

Stigmata,
Thanks for your follow up reply. In calling 1 of the 4 insurance companies I'm paneled with (C$%na),

I spoke with the main claims representative. I explained that I'm working at a group practice and am paneled with their insurance company at this practice. What I want to do is... at MY just started private practice service their insurance holders (for whom I will get referrals independently from the group practice where I also work).

This person informed me that this wouldn't work. That I would HAVE to accept their insurance holders, apply for reimbursement... AND that it wouldn't be possible to get reimbursed separate from my group practice.

I asked whether it would be possible simply not to "register" my private practice with them, accept cash from the client, and agree with the client that he/she will handle reimbursement. The short answer was "no."

I will be calling the other 3 insurance companies over the next couple of days. From worst to best here it seems are the potential options:

3. Just accept clients that are paying cash, inform them that it may not be possible to get reimbursed via their insurance by seeing me (have them sign a form proving that they were informed of that?)

2. Simply accept insured clients provided that it is indeed possible to be paneled at two locations and receive payments at different locations (the group practice and my private practice), meaning I'll handle reimbursement paperwork at my private practice.

1. do as you suggest, Stigmata, accept cash payments from clients, have them handle reimbursements.
E.g., give them a superbill that states your Dx, and code for the service provided (90801, 90806 etc..). They use the superbill to get reimbursed directly from the insurance.

I don't mean to over rely on the helpfulness of this forum, but do you think my chain is getting yanked by this particular insurance claims representative? I talked to 2 separate people and this person represented himself as the authority on the matter. Thanks for any other pieces of advice. I'll be calling the other insurance providers over the next couple of days.

 

[stigmata]

Yes, your chain is getting yanked and it always will by insurance companies. The only benefit to being on their panel is for them, not you. Do not join their panel, accept direct payment for your services and let the patient get reimbursed from their insurance. Nearly all plans have alottments for out-of-network providers. One thing you need to remember, you have 0 clout with an insurance company, but your patient has quite a bit.
They are correct on one point and that is that IF you choose to be on their panal you agree to the terms they provide and must bill the insurance, so just stay off the panels.

 

[Therapist4Chnge]

They are correct on one point and that is that IF you choose to be on their panal you agree to the terms they provide and must bill the insurance, so just stay off the panels.

I think that will be his issue though. I have a suspicion that if the group practice is taking insurance that they are doing it through a panel and not as an out-of-network provider and/or FSA reimbursement. The OP is trying to split out his "individual" practice from his "group" practice, but in the eyes of the insurance company he is a provider, who most likely is on the panel, and they don't much care if he practices alone or with 100 other psychologists.