Insurance Reimbursement for Psypact Therapist?

[asukaran]

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Hi guys,

If I hold a license and reside in State A, and I see a client who lives in State B through PSYPACT, with insurance coverage (e.g., Blue Cross Blue Shield of State B), can I be reimbursed by their insurance company if I am credentialed with Blue Cross Blue Shield in State A? I understand that policies differ across insurance companies, but could you clarify which insurers reimburse PSYPACT providers even if the provider is not separately licensed in the client’s state (State B)? Thanks!

 

[WisNeuro]

Yeah, you're going to need to call BCBS and likely spend a good hour or two on the phone with someone you can barely understand to get an answer. Policies of insurance companies is often regional, to some extent.

 

[PsyDr]

No.

Each state insurance is a separate company, even if it has the same name. This is because insurance is licensed by each state. "ACME Insurance of State A" is a licensed professional company in state A, by state A. In the case of BCBS, it is 34 different independent companies. You might have a contract with" BCBS of State A", but not contract with "BCBS of State B". BCBS of State B has no contractual obligation to pay you for anything.

The major exception to this requirement is Medicare, which is divided by "regions". You can contract with the regional administrator of a region, which might cover several states. However, you will not be reimbursed if you see someone in Region B unless you have a contract with that region's administrator.

 

[ClinicalABA]

This is all further complicated by the type of insurance plan- self-funded or fully insured. Self-funded plans (where the employer pools all the premiums and uses that money to play out insurance claims, and thus more common with large companies with many employees) are subject to federal legislation (vs. state legislation), and will have different benefits (often required to cover less than fully funded/state regulated plans). These self-funded plans are often administered by a commercial insurance agency, and- ime- the client/patient usually does not know what type of insurance they have, beyond just knowing its "Blue Cross/Blue Shield" (I use BCBS as an example only- I don't know if they manage any self insured plans).

TLDR- you or someone who works for you needs to confirm that you can and will be reimbursed by the client's insurance, and at what rate. You also need some signed documentation from the client where they are told to the cost of you services and agree to pay for whatever insurance does not cover.

 

[psy.d. 2021]

So, basically what I'm hearing is for a solo practitioner to take on clients out of their home state (state A) it would be a pretty heavy administrative lift. Likely not worth it? Would joining headway or something similar who do insurance verifications for you streamline this?

 

[WisNeuro]

So, basically what I'm hearing is for a solo practitioner to take on clients out of their home state (state A) it would be a pretty heavy administrative lift. Likely not worth it? Would joining headway or something similar who do insurance verifications for you streamline this?

Yup. Whenever someone comes to me with an out of state insurance, I tell them I need something written from their company that says they will reimburse me. I'm not sitting on the phone for 1-2 hours to figure it out. I have a waiting list, I don't need to spend time on this junk. Furthermore, they sign my consent form saying they will pay $x/hr if said insurance doesn't pay. This doesn't come up all that often, mostly because I have more than enough work, so I can easily pass them off to a place with a billing department who will sift through the nonsense that is US healthcare via insurance.

 

[PsyDr]

So, basically what I'm hearing is for a solo practitioner to take on clients out of their home state (state A) it would be a pretty heavy administrative lift. Likely not worth it? Would joining headway or something similar who do insurance verifications for you streamline this?

It's really not that hard to sign up for insurance companies. If you're just aching to give someone 40% of your take home, I'll sign you up for insurance companies and you can remain self employed.

 

[WisNeuro]

It's really not that hard to sign up for insurance companies. If you're just aching to give someone 40% of your take home, I'll sign you up for insurance companies and you can remain self employed.

Yeah, I never understood the exorbitant fees some people pay to get credentialed. Especially after you've done the process once, it's super easy.

 

[PsyDr]

Yeah, I never understood the exorbitant fees some people pay to get credentialed. Especially after you've done the process once, it's super easy.

It's a form. They have a simple question, and you fill it out. Name? License number? Address? Hours of Operation? They are simple questions. They're not asking for a proof that Godel's incompleteness theorem can be used in a theory of everything.

Takes an afternoon or less. If you can apply to college, you can fill out an insurance form.

 

[psy.d. 2021]

It's really not that hard to sign up for insurance companies. If you're just aching to give someone 40% of your take home, I'll sign you up for insurance companies and you can remain self employed.

I'll pass, I can do it based on what you're saying, just is annoying. For PSYPACT, now we're talking 42 forms, and that's just for BCBS. Then navigating the BS that comes with each one of them and making sure the person remains verified so you get paid. So I can understand if some people want to pay something of a big lazy tax just so they can do clinical work and call it a day. Especially if this is all unknown territory for them.

 

[PsyDr]

I'll pass, I can do it based on what you're saying, just is annoying. For PSYPACT, now we're talking 42 forms, and that's just for BCBS. Then navigating the BS that comes with each one of them and making sure the person remains verified so you get paid. So I can understand if some people want to pay something of a big lazy tax just so they can do clinical work and call it a day. Especially if this is all unknown territory for them.

1) It sounds condescending and arrogant when I make the offer. It should sound exactly the same when someone else tries to scam you out of your hard earned income.

2) You can always fill out one BCBS form, make sure it’s accepted, and then hire someone through a temp agency to copy the material to the other 41 states. $400 should cover it at $20/hr. That’s a crapton better than 40-60%.

 

[WisNeuro]

I'll pass, I can do it based on what you're saying, just is annoying. For PSYPACT, now we're talking 42 forms, and that's just for BCBS. Then navigating the BS that comes with each one of them and making sure the person remains verified so you get paid. So I can understand if some people want to pay something of a big lazy tax just so they can do clinical work and call it a day. Especially if this is all unknown territory for them.

Why would you want to be credentialed for an insurance company in 42 states unless you were a large telehealth company? And, in that case, you have an employee handle that in-house. Between your home state and a select few others, you should easily be able to fill a schedule. Most people can do that with just their home state.

 

[ClinicalABA]

Why would you want to be credentialed for an insurance company in 42 states unless you were a large telehealth company? And, in that case, you have an employee handle that in-house. Between your home state and a select few others, you should easily be able to fill a schedule. Most people can do that with just their home state.

Not to mention how would you be able to be up to speed with the different psychology related legislation in each state (e.g., mandated reporting procedures; involuntary commitment processes; duty to warn; record retention)? All of these different regulations are largely meant to protect the public from us. Providing services without knowing about the pertinent regs- Psypact or not- is just asking for trouble.

 

[Sanman]

Not to mention how would you be able to be up to speed with the different psychology related legislation in each state (e.g., mandated reporting procedures; involuntary commitment processes; duty to warn; record retention)? All of these different regulations are largely meant to protect the public from us. Providing services without knowing about the pertinent regs- Psypact or not- is just asking for trouble.

This is an often overlooked point with telehealth. That said, if you are picking up only a few other states, you can familiarize yourself with the processes and screen your cases carefully. I have now practiced in 5 states between in person and telehealth. I have not found mandated reporting requirements to differ greatly between those areas. There is e911 to assist with emergent issues.

 

[WisNeuro]

This is an often overlooked point with telehealth. That said, if you are picking up only a few other states, you can familiarize yourself with the processes and screen your cases carefully. I have now practiced in 5 states between in person and telehealth. I have not found mandated reporting requirements to differ greatly between those areas. There is e911 to assist with emergent issues.

I just don't see the point unless you are in a super saturated area. I restrict who I take clinical referrals from and I'm still booking out months in advance. As for other state licenses, I only carry more than my home state for medicolegal purposes, as I am one of the few npsychs who will travel for medicolegal work and I charge a lot of money to travel on top of my eval fees. On top of reporting requirements, the more states you're in, the more billing headaches you're asking for. Just seems like a good way to eat up a lot of unbillable time.

 

[Sanman]

I just don't see the point unless you are in a super saturated area. I restrict who I take clinical referrals from and I'm still booking out months in advance. As for other state licenses, I only carry more than my home state for medicolegal purposes, as I am one of the few npsychs who will travel for medicolegal work and I charge a lot of money to travel on top of my eval fees. On top of reporting requirements, the more states you're in, the more billing headaches you're asking for. Just seems like a good way to eat up a lot of unbillable time.

For insurance based work I agree with you. My goal for telehealth would be for a completely out of network practice.

 

[WisNeuro]

For insurance based work I agree with you. My goal for telehealth would be for a completely out of network practice.

At which point you don't need to worry about credentialing anyway. 🙂

 

[Sanman]

At which point you don't need to worry about credentialing anyway. 🙂

I think @psy.d. 2021 and some of the younger folks are more concerned with short term cash flow than longer term practice concerns. I would advise those folks to consider some short term contract work while building a cash practice longer term or limit their practice in some way.

Really you need to sit down and write a business plan that thinks through what kind of practice you want.

 

[WisNeuro]

I think @psy.d. 2021 and some of the younger folks are more concerned with short term cash flow than longer term practice concerns. I would advise those folks to consider some short term contract work while building a cash practice longer term or limit their practice in some way.

Really you need to sit down and write a business plan that thinks through what kind of practice you want.

That business plan should NOT involve credentialing with 42 states, nor getting into bed with Headway.

 

[ccpsych16]

I just went through this. I spoke to Aetna and they told me my rates are based on the state I reside in. Clients can use their benefits if they have an Aetna plan that gives access to the national network. If they don’t (like a state restricted plan) they I would be OON for them. Much like how I currently travel out of state to see some doctors (not Aetna) and I pay my same amount as for in-state doctors. As long as they’re in the national network I can see them.

EDIT: to add, I did submit an application for a separate state I’m independently licensed in. They said that didn’t matter because it’s based on where the service is provided. If I don’t physical go to that other state and deliver care, then those rates don’t apply.

EDIT2: also, telehealth is sometimes reimbursed at the lower “facility” rate instead of the higher office rate. A real bummer.

 

[Sanman]

That business plan should NOT involve credentialing with 42 states, nor getting into bed with Headway.

As much as I am not a fan of Headway, it probably still beats some PP splits.

 

[PsyDr]

Really you need to sit down and write a business plan that thinks through what kind of practice you want.

Can you imagine the work hours of treating people on both coasts?

 

[WisNeuro]

As much as I am not a fan of Headway, it probably still beats some PP splits.

If you're going to be doing telehealth with Headway, there is little reason to not just go solo PP.

 

[Sanman]

If you're going to be doing telehealth with Headway, there is little reason to not just go solo PP.

Corret me if I am wrong, but telehealth with headway would be solo PP. I thought they just handle insurance rate negotiation, billing, and credentialing as well as EHR.

If you are going to take insurance, the question is can you negotiate a higher rate than Headway can after their cut.

 

[WisNeuro]

Corret me if I am wrong, but telehealth with headway would be solo PP. I thought they just handle insurance rate negotiation, billing, and credentialing as well as EHR.

If you are going to take insurance, the question is can you negotiate a higher rate than Headway can after their cut.

Shouldn't need to. Just take a few of the highest paying and offer cash pay for anyone OON. Assessment is a little different, but I only take 3 insurances, anyone outside of that, can take or leave my cash pay rate. No problem filling my clinic. As for therapy, there is a shortage of providers I'll actual personally refer to.

 

[WisNeuro]

As another point, billing really isn't hard. For a solo therapist, they could do it themselves for every other week in about 1-2 hours. If you really wanted, you could pay someone an hourly rate to do it.

 

[Shiori]

This is starting to feel like the difference between people who chop their own fruits and vegetables vs buying them chopped already. Different values and preferences.

For clarity: People will pick the convenient option like Headway even if the process to get paneled and do their own billing is relatively quick and easy. Chopping vegetables is also easy. People still buy chopped vegetables all the time.

 

[Sanman]

Shouldn't need to. Just take a few of the highest paying and offer cash pay for anyone OON. Assessment is a little different, but I only take 3 insurances, anyone outside of that, can take or leave my cash pay rate. No problem filling my clinic. As for therapy, there is a shortage of providers I'll actual personally refer to.

Don't disagree, but I would treat them the same way as any insurance contract. If they happen to be one of the better offers use them. Their value is only there if they can negotiate a better rate than you or them same rate with less billing work.

 

[WisNeuro]

Don't disagree, but I would treat them the same way as any insurance contract. If they happen to be one of the better offers use them. Their value is only there if they can negotiate a better rate than you or them same rate with less billing work.

Perhaps, I just wouldn't be surprised when they start taking bigger and bigger cuts. I would predict a sale and/or IPO in the next few years. Shareholders want that money. I'm also surprised at how many people bitch about PE takeovers in MH, but then quickly turn around and sign up for Headway/Rula/etc.

 

[Therapist4Chnge]

Perhaps, I just wouldn't be surprised when they start taking bigger and bigger cuts. I would predict a sale and/or IPO in the next few years. Shareholders want that money. I'm also surprised at how many people bitch about PE takeovers in MH, but then quickly turn around and sign up for Headway/Rula/etc.

This repeats over and over for companies that need to continue to show "growth", especially when they have new investors who buy in late. Look at Uber & Lyft....they had a more reasonable split in the beginning, and it has degraded from there. Now look at Doordash/Postmates/UberEats....same thing. The Headway split is already laughable and predatory, but it's only going to get worse for existing clinicians. Unrelenting Capitalism in action.

 

[WisNeuro]

This repeats over and over for companies that need to continue to show "growth", especially when they have new investors who buy in late. Look at Uber & Lyft....they had a more reasonable split in the beginning, and it has degraded from there. Now look at Doordash/Postmates/UberEats....same thing. The Headway split is already laughable and predatory, but it's only going to get worse for existing clinicians. Unrelenting Capitalism in action.

Yep, we've already seen from existing models, a lot of people will complain, some will leave. Most will stay, and a sizable portion of those who left, will come back, and Headway's profits will be better than ever. Healthcare will further degrade, and providers will have had a huge part in making that happen.

 

[Sanman]

Perhaps, I just wouldn't be surprised when they start taking bigger and bigger cuts. I would predict a sale and/or IPO in the next few years. Shareholders want that money. I'm also surprised at how many people bitch about PE takeovers in MH, but then quickly turn around and sign up for Headway/Rula/etc.

For sure, I would not recommend it as a long term career plan. But, I would not recommend taking insurance either. Rather, I think it can be a bridge to cash practice if the rate quoted is reasonable.

That said, it is a spectrum of bad. I had a recruiter call me not long ago and offer me less than $37/session (90832) to drive to a nursing home and see patients. Just got another from a telehelath start up offering $100/session (90837).