Insurance providers paying for predoctoral intern services

[deleted760483]

Hello All -

I am hoping to gather some information on which insurance providers have reimbursed predoctoral interns for psychological services. I live and work in Iowa and am attempting to create a generalist predoctoral internship here as this area is sorely lacking in mental health services, but currently there are no payers in my area who are willing to pay for services of a predoctoral intern. We are attempting to negotiate reduced rate contracts for supervised intern services and they are wanting information about how this is handled in other states. I only know Iowa and Minnesota, where BCBS did pay a reduced rate for me when I was an intern, but no other payers did. Any help is appreciated. Thank you!

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[Ollie123]

This is going to be very state-dependent. We are able to bill for interns (or even prac students) assuming it occurs under supervision of an attending in NC. I believe all private insurers that we take will currently pay and at the same rate as the attending would bill. Some of this may have to do with setting, the credentialing system in place and negotiating power of the system. We're a massive university system that has taken over much of the surrounding area, has quality of care stats to back us up and is really only the option for certain services anyways. In other words, far more power to force things down the throat of insurers than other settings might have.

 

[deleted760483]

I know that it is very state-dependent, but there is no precedent for this in Iowa as the only predoctoral internship programs here are universities and VA's so their billing practices are very different from ours. BCBS accounts for about 40% of our caseload so they are the main provider we are trying to negotiate with and they specifically asked me to look into how BCBS in other states handles reimbursement for services rendered by supervised interns. In many ways Iowa is about 10-20 years behind the rest of the country with regard to behavioral health I work for a midsized hospital in a midsized urban area (240k people). We are one of 3 service providers for behavioral health other than college counseling centers and a few individual practitioners running private practices. There are 11 registered, practicing psychologists in this area....

 

[deleted343839]

The model I'm familiar with is the same as Ollie mentioned, with the supervising psychologist as the billing psychologist, and the trainee treated as an "extender" for billing purposes. Reimbursement is the same as the regular licensed psychologist rate. Different states have different stipulations about whether/how the billing psychologist is directly involved in the patient's care.

 

[deleted760483]

That's the model I am trying to emulate and our insurance contact at BCBS-IA told me they wouldn't pay for services provided by an intern but billed under a licensed psychologist who is supervising the intern and signing off on all paperwork.

 

[deleted343839]

That's the model I am trying to emulate and our insurance contact at BCBS-IA told me they wouldn't pay for services provided by an intern but billed under a licensed psychologist who is supervising the intern and signing off on all paperwork.

If no one else in IA has implemented this model you have an uphill battle on your hands. Have you reached out to your state psych association?

 

[PsyDr]

Part of this is the entire cms policy being followed by private insurers thing. Cms won't allow trainees to be funded because federal dollars are used to fund residencies, at least for medicine), so billing Medicare would be double dipping.

I would call a higher up. Even better: go to their physical office. I recently had a problem with bcbs, where they hung up on me, demanded I fill out a form which they couldn't provide, etc. After 2-3hrs, I drove to their physical office, politely explained the problem, and informed them that I would quietly sit in the waiting area until someone was available to solve this problem even if this meant being there after hours... Amazing how quickly everything was handled.

Other more aggressive solutions I have used, but am not proud of: informing insurances that my next phone call was to our city's investigative reporters (using a name and providing a timeline helps here), calling the state insurance commission (but I have a friend in the executive level here), calling the relevant state congress person and explaining how their actions are harming their constituents, tweets, calling the CEO directly (you can do it, they won't take your call, but stuff magically gets solved), providing a handout to potential patients indicating that their insurance company won't pay for their services, etc.

But I am probably more aggressive than most.

 

[temppsych123]

Vague recollection from interviewing for internship that, in Wisconsin, to be able to bill, the person who is licensed has to physically be in the room with the client for at least some amount of time during the session. So your intern can bill at the psychologist rate for a one-hour session as long as the psychologist physically comes in at some point. I think people varied in terms of how long they were actually in the room. Might want to reach out to internship program directors in other nearby states to see what they've experienced? VAs are, as you surmised, less likely to have relevant info for you, but even internships at large hospitals that don't "need" the money from the interns may still be able to answer some of your billing inquiries.