If you are a therapist, you are providing a medical service.
Mental Health care is a part of being healthy and having someone to guide you
is just as important as having a doctor to give you a check up – check your
vitals, run some blood work, treat an illness. So therapists are professionals
who have the ability to be paid by health insurance. Now… there are hundreds if
not thousands of companies – more so now than ever – that offer insurance and
pay providers in their networks.
I started off working a full time job while seeing clients through
2 EAP providers - that’s Employee Assistance Programs. They don’t pay well but
the client work is interesting. The credentialing was pretty easy as well.
Clients usually self refer and have a limited number of sessions that the
company pays for. Beyond that I offer a reduced rate for them to continue for
the same number of sessions they got through their benefits.
How can any one therapist get credentialed with all of these
companies? Recently, I joined Cigna, and it was a fairly painless experience.
They were efficient about sending documents back and forth, my recruiter
communicated with me often, when everything was done they credentialed me in 3
weeks, when they had up to 90 days. I have been told by another Cigna provider
that they pay timely and have been good to work with. Their rates are similar to
what I have seen, mostly Medicaid rates but clients usually have a co-pay.
Medicaid credentialing, here in Colorado anyway, has been a completely
different sort of animal.
One therapist in a cohort group I’m in on Facebook said she
contracted out her credentialing to someone who does it for a living – a medical
biller or something. I had no idea people did that although it makes sense
because doctors who open a practice have to accept a lot of insurances and they
have even more documents to provide. Do they have time for that? I don’t think
so. My mother has offered to help me do billing and what not and I could add
her to my profiles as an office person, but I would prefer to pay her and I can’t
right now and I don’t think I really want to join more insurance panels. I can
take any client with PPO benefits – meaning they can see someone out of
network. They pay me then submit the bill to their insurance to be reimbursed. The
last person who asked me about that discovered she had to meet a huge
deductible before she would be reimbursed anything. I tried to sign up with her
insurance but they are not accepting new providers in my county unless I can
prescribe and/or speak a language not usual for the area, like Farsi or Somali.
Getting back to Medicaid. In Colorado, the State was divided
into regions a few years ago and companies bid on regions. I live in Adams
County – which is covered by BHI. I want to work with kids from Denver (foster
care) and Morgan Counties, these are covered by ABC. A friend of mine said to
apply at Colorado Access. They had no application – they said send us an email.
They emailed back: we don’t need anyone right now. I thought, that can’t be
true! I went on the State Medicaid site, was able to apply and be approved as
of June 1. However, if you’re not part of one of the managed care entities, you
will bill and not get paid. Sadly, I am not going to get paid for a few
clients, but I am okay with that now. They needed the help, they got better and
I am not going to take any more until I can get paid.
I finally reached someone about my questions with BHI and
she was great at explaining all of this to me. I sent in my documents, waited, and then was
told that I passed round one and in a months she and the team would start round
2. I had to send her more documents, that I really could have sent her with the
first round had she asked. I am very close to being done, I have clients in a
rural county Human Service Agency waiting for me to start. That was the reason
I got ABC coverage in the first place, otherwise I would have been declined
(there is a need for therapists in the rural areas). There has been so much
outrageous duplication and waste in these processes. Being a Black Belt in
LEAN/Continuous Process Improvement, I have truly struggled to be patient with
the inefficiencies.
CAQH is a national clearinghouse for billing. Cigna required
me to join so they can pay me and credential me through this company, however
Medicaid wanted my number as well. There are a few more similar companies,
depending on which insurance panel you are on. Again, duplication. Now Colorado
has a ballot initiative this fall for a single payer system. I can really see
the benefit to this but man if I have to scrap everything I have done to date
just to join that one I might lose my ever loving mind.
In the meantime, I do a few other things – I do paintingparties, I sell my art as much as I can, I have done a training on Primary
Perpetration Prevention for foster parents through Foster Source, a new support
agency a neighbor of mine started this year. I saved up before I quit so I
could have flexibility and a nice summer with my kids. I signed up (aka invested) for a Business School Bootcamp
for therapists because I need to know MORE of how to make this work. Marketing,
networking, getting referrals, it’s all part of this thing we do and it is an entrepreneurial
business. It is not a passive activity. While I want to help people of lower
income and who have struggled more to get ahead, I deserve to make a decent
living doing it. So do you!
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