One of the most frequent questions a counselor is asked during the inquiry stage is, “Do you take my insurance?” As the need for mental health care increases, the most common answers to this question are generally:
1. “No”
2. “Yes…but there is a waitlist.”
Client’s seeking counseling often become frustrated when they are looking for a counselor who bills their insurance. And it IS frustrating! Shouldn’t counselors want their services to be accessible?
Trust me – we do!
Having worked in administration and management for practices that do take insurance, and now being in the minority of counselors in our area who happen to bill insurance, I can tell you about the *many* difficulties with this process. Here are just a few of them…
Credentialing: Credentialing is the application process a provider must complete in order to be considered “in-network” for an insurance panel. While insurance companies estimate that this process takes ~30-90 days, it is fairly common for the process to take over six months for some counselors! And then, the applicant can be told there was something wrong with their original application, or even that the panel has determined that no new in-network providers are needed. Further, each panel has a different credentialing process and some panels contract out their mental health benefits to third-party managed care organizations (meaning the counselor also has to be credentialed with these additional panels).
Keep in mind, all of this up-front administrative work to complete credentialing is unpaid.
Complications of Authorizations and Billing: Once a counselor is credentialed, then they still need to check benefits for authorization on each client. Again, because each insurance panel has entirely different process’ for checking benefits, authorizing services and then billing for those services mean nothing can be easily streamlined. Most of the online portals are not user-friendly, and, often times, are not updated with correct information. Some panels require that a provider call (*que On-Hold music*) to request prior-authorization before billing for a service. Likewise, submitting claims can be just as confusing.
Payment: Even if a counselor makes it through credentialing and learns how to check benefits, they are then obligated to sign a contract stating that they understand the insurance company can still deny payment AFTER services are rendered! Essentially, I could become an in-network provider with your insurance panel, determine you have a small copay, see you for counseling, and then bill your insurance company… only to have the claim denied.
Further, many of the most common insurance panels have very low reimbursement rates for counseling. Most reimburse at lower than what counselors need to charge to cover their overhead. And, even IF an insurance company does pay, counselors are STILL at risk for audits and recoups. This is when the insurance company comes back to collect money they believe they “over paid.” (We could write a whole separate post about the many *unpaid* hours of work that go into each client, but we’ll save that for another day).
Therefore, I personally don’t foresee a large increase in counselors taking insurance until there is massive systems change in mental healthcare. Here are some alternatives for finding accessible mental health services in your area—because we counselors want this as much as you do!
Sliding Scale: Many counseling centers offer sliding scale services. This essentially means they will lower their rates based on your income. Here at ETCG, we have graduate counseling interns who offer sessions on a sliding scale.
Submit Your Own Claims: Most clients are scared by this suggestion—but it can be very effective! If you are able to front the cost to pay your counselor directly and then request a “super bill" to submit to your insurance panel, then most insurances will likely reimburse you for out-of-network services. There are even apps, such as Reimbursify, that will do this for you! All you have to then do is upload a copy of the super bill to the app, and they will seek reimbursement from your insurance company on your behalf for a modest fee. If you have the ability to cover your own initial costs, and then can do the extra work to submit your own claims, you will also leave more space on the waitlists for those who truly can’t afford the cost up front. Thus, you are even helping improve the well being of others in a tangible way.
Get on a waitlist: IF you have no choice but to use your insurance, EXPECT a waitlist and try to put your name on a few waitlists BEFORE your situation becomes urgent.
Prioritize your mental health: IF you are able to do so, consider re-prioritizing your spending. We understand there are many people that do not have this privilege. However, it is not uncommon for people to utilize other services of value that are not covered by their insurance, such as chiropractors, homeopaths, nutritionists, personal trainers, etc. Mental health is at least as valuable as those out-of-pocket services.
Although I am grateful to have found ways to be in-network with some plans, I know of MANY other fantastic counselors who are unable to do so because of the limitations addressed in this post. It is also one of my passions to help break down barriers to accessible counseling. So, it is my hope that this information helps you better understand the systems we are working in—and gives youideas for how to find the support you need!
We have a large variety of rates and services available at ETCG. Please feel free to reach out and let us help connect you.