There are thousands of mental health providers who decide to venture out into the world of private practice who are totally unaware of how insurance may, or may not play a part in the success of their firm.  Like any other type of provider, you must be aware of the rules of working with insurance as it pertains specifically to your profession. 

 

First, you need to decide what type of insurance may be beneficial to your practice.  There are hundreds of commercial carriers (aka private insurance) and state health programs (like Medicare and Medicaid) and even military (Tricare or formerly CHAMPUS).  This is crucial when it comes to contracting with these carriers and the credentialing process you must go through to become contracted with them (aka an in-network provider).  For instance, if you are wanting to work with state health programs, you have to be licensed at a certain level in order to contract with Medicare and not Medicaid.  In addition, there are specific guidelines within an individual's policy that will dictate whether a procedure is covered or not based upon the type (licensing) of the mental health provider they are seeking.  For example, the insurance may only cover a procedure completed by a licensed psychologist and not a licensed professional counselor.  Keep in mind that insurance will also require you to update, or re-credential at least every two (2) years.  You also want to take into consideration what type of patients you see and are able to help; so what services you provide.  Do you work with minors, with sexual based issues, with substance abuse issues, with individual or group counseling?  This too will be a determining factor of the type(s) of insurance you may want to work with.  Upon submission of a credentialing application with an insurance carrier, keep in mind that acceptance is not only dependent upon your qualifications and licensing to complete the job you say you can, but also on where you are located and whether your 'market' is saturated with other providers in your area already apart of that insurance's network.

 

Once you have gotten past that part, you also want to make sure that you familiarize yourself with basic insurance policy terminology/requirements such as; pre-authorizations, co-payments, deductibles, co-insurance, visit limitations, out of pocket maximums and any exclusions.  While it always considered the responsibility of the patient to know this information, so should you to ensure that you are collecting all monies due to you upfront.  You don't want to play the chasing game!  You also want to make sure that your HIPAA/Privacy Policy is in place, along with your Financial Policy.  All should be reviewed and signed by the patient prior to any treatment.  Last, how are you going to submit claims and follow up to make sure reimbursement has been received promptly?  If you intend to just mail claims in, expect long wait times to receive your payment-between 45 - 60 days on average.  If you have the means to submit claims electronically, the preferred and in some case mandated way, expect payment within 20 - 30 days on average.  The most sensible option as your business grows and you have less time to worry about claims and follow up is to either hire someone experienced to work in the office with you to handle this, or out source to a reputable billing company.  Done correctly, taking insurance can be profitable and very beneficial for you.  Always remember, if you're not sure, make sure to ask.