PhD/PsyD insurance reimbursement in mental health

[n2b8me]

I am just starting a private practice after working at a substance abuse and community-based mental health service agency for several years. I am realizing quickly that I am getting a lot of new clients through insurance referrals. I am now a credentialed provider for many major insurances cigna, compsych, blue shield, magellan, mhn, ceridian and have received many referrals and a budding client base. GREAT!

BUT, there is so much paperwork and phone calling regarding preauthorization, copay fees, reiumbursement status.

I have been referred to a couple of people through colleagues that can help me take care of all of these billing/paperwork issues. GREAT!

BUT, these private individuals say they need my logins for the various website portals to access claims and check reimbursement status. Sounded fishy to me, but when I called around to my colleagues and other people in the field they stated this is the norm.

Does anyone else in private practice that accepts insurance use these type of billing services and if so what has been your experience?

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[erg923]

I dont have an answer for you but if these logins reveal some of your private info (SSN, etc.) then, NO. I would never share that information with anyone.

 

[WisNeuro]

I dont have an answer for you but if these logins reveal some of your private info (SSN, etc.) then, NO. I would never share that information with anyone.

Admittedly, I don't deal with billing, so it's a naive area to me, but if they are billing for you, at some point I imagine you would have to provide a SSN for income reporting purposes. I would find people in your area, find out who they use. Additionally, I always check companies profiles through the Better Business Bureau, if they are a longstanding company with few or no complaints, you're probably good to go.

 

[bcliff]

The practice where I used to work used a very small, local company to handle all of their insurance (preauth/claims/verification/etc.), and yes they were given access to all of our login information. After a while though, my boss decided to stop using this company, and in an attempt to save money, passed the buck to me to (the psychometrist) to handle all of the insurance verification & authorization, and one of the receptionists to handle claims.

In my experience, the process isn't as complicated as it is tedious - I was hardly given any training and learned most of what I know about insurance on the job, like what types of things are important to ask (i.e. effective date, PPO/HMO, deductible?, copay/insurance?, preauth required [and then the inevitable are you sure preauth isn't required for psychological testing], etc.).

If you're concerned about account security, I would recommend bringing on some kind of an assistant/psychometrist that can help with testing administration & scoring and also use some of that down time to work on insurance. It's likely more expensive to do this than to simply hire a third party, but it will allow you to keep all of your personal and account information in-house.

 

[ikibah]

Rookie question I presume, but what are insurance referrals?

 

[erg923]

Not trying to be snarky, but its exactly what it sounds like. Referrals that come as a result of being paneled /being "in network" with an insurance company.

 

[ikibah]

I have no idea what that means. Say I'm "in network" who is referring clients to me?

 

[bcliff]

I have no idea what that means. Say I'm "in network" who is referring clients to me?

For example, you're contracted with BCBS, then someone in your area with BCBS mental health coverage calls BCBS and asks 'I would like to see an in network psychologist that is close to where I live', and then BCBS gives them your name along with any other providers. If they elect to see you, then this would be an insurance referral.

 

[erg923]

I have no idea what that means. Say I'm "in network" who is referring clients to me?

It means you are "paneled" (approved) by the insurance company to see their patients. Im not sure if you have a PCP or not, but if you do, you likely checked with your insurance carrier to see what providers they "recommend." Same thing...

 

[ikibah]

For example, you're contracted with BCBS, then someone in your area with BCBS mental health coverage calls BCBS and asks 'I would like to see an in network psychologist that is close to where I live', and then BCBS gives them your name along with any other providers. If they elect to see you, then this would be an insurance referral.

Ahh...got it. Thanks.

 

[Sanman]

They should not need your SSN. The will need your personal/business tax ID number as well as your provider number for the panels, license number and NPI number. The SS may be required on your application to become paneled, but you can do that yourself.