How to Get Mind-Body Tools Reimbursed By Insurance Companies

Dec
27
2011
by Tamara Suttle

In addition to being licensed as a Professional Counselor, I am also a Certified Clinical Hypnotherapist soHow to Get Reimbursed by Insurance for Mind-Body Tools it should not surprise you to know that I was reading Belleruth Naparstek’s blog, Health Journeys today and stumbled across an excellent post she wrote (back in August) on getting reimbursement from insurance companies for the use of mind-body tools.  Here is what I took away from her post . . . .

Don’t make things harder than they need to be. It reminds me of what my first partner, a scrub tech, used to tell me . . . . A surgeon can call a mass “a mass” or  “a cyst” or “cancer.”  And, for some masses more than one of those words may be accurate.  However, the rate of reimbursement was / is contingent upon what s/he chooses to call it.  The same is true for your services.  Sometimes you have choices . . . and it benefits both you and your client to make both accurate and informed choices when it comes to the services you provide.

Persuasion is simply “applied empathy.” It is a skill that you have either developed or you have not.  Don’t psych yourself out when talking with managed care.  If you have the ability to apply your empathy to your client, you also have that same ability to apply your empathy to those who work in managed care.  Put yourself in their seats so that you can speak to their unique concerns – those of balancing health care and restricting costs.  And, if you are unable to apply your empathy there, then check yourself.  That may be a skill that needs polishing . . . as it would benefit both you and your client.

Language matters. I know I’ve written about this before.  Belleruth’s references to both managed care and the military are excellent examples of why this is so important.  Different cultures speak different languages.  If you are choosing to work within the culture of managed care, learn the language.

You need a Supporting Data File. Belleruth refers to this as “robust research data.”  Whatever you call it . . . for whatever you do . . . keep your research data file current and easily accessible.  It may be what gives you the upper hand in securing a contract to provide your services.  (And, if a portion of what you offer falls under Complimentary / Alternative Medicine, then you need to double your efforts here.)

Doing your homework on each insurance company goes hand in hand with strategic networking. You’ll need both in order to find and persuade those with the influence necessary to approve of your mind-body services.

If you have additional tips that have helped you secure reimbursement for your services, I hope you’ll take a moment to share them below with our readers.

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On 13 Insurance Panels And The Phone Isn’t Ringing

Dec
20
2011
by Tamara Suttle

Sometimes in trying to get a practice started, Image of On 13 Insurance Panels & the Phone Still Isn't Ringingit’s easy to overlook logical steps.  Last month, I received a couple of emails from a reader that I’ll call “Stephanie.”  Stephanie wrote . . .

I am on 13 insurance panels, have been doing everything possible (since April) that I know how to do and have not received one call.

I would do anything to accept private pay.

My unemployment benefits ran out in September and I applied for food stamps yesterday.

I am revising my website for the third time to focus on clients who are ________ and are non compliant in hopes I can market to and get referrals from physicians.

I never thought it would come to this. I am trying not to panic”

And, in a follow up email she wrote . . .

I have not built a referral base. I’ve been working in agencies with clients who are ________. Not my ideal clients. I only recently returned to the city and know few in private practice. I have been working on marketing 8-12 hrs a day, but not getting ‘out there’. I don’t know how.

I am changiing my niche to aging and dementia using CBT. Not many therapists do this.

I am 55 and have also tried for 2 years to get a job to sustain me.

I sound pathetic but am not. I am determined to make this private practice work. All I need are five clients to start so I can survive.

I hate the idea of insurance panels but I have no choice. I am desperate.

You can use my note but not my name.

I value any advice you can give and thank you for your kind words.”

I thought this might be a good opportunity for you to help Stephanie out.

What is she doing well?

What might be her strengths?

What seems logical to you that she might be missing?

Wiithout any magical solutions, without making anything up, and without adding any information that you have not been given – can you comment on what Stephanie might need to hear and focus on to get her practice on track?

And, what is the logical step that you are missing in your own marketing efforts?


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Filed under: Grow Your Practice, Inspiration, Insurance | Managed Care, Networking, Referrals, Stress Busters, Technology, To-Do's Tagged with , , , , ,
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The Language Of Managed Care – What To Say And How To Say It

Oct
13
2011
by Tamara Suttle

If you have chosen to work directly with managed care companies and now find yourself struggling to work effectively with them, you may not be speaking their language.  Theirs is the language of behavioral health care.  As such, it focuses on impairments.

Impairments are behavioral dysfunctions.  They are quantifiable and measurable.

Biopsychological impairments address both the biological and psychological spheres of a client’s life and include such things as altered sleep, learning disabilities, and psychotic thought.

Family / significant other impairments are those Image of Speech Bubblesthat reference a client’s difficulty in relating to significant others such as family or marital dysfunction, emotional / physical trauma as a victim or perpetrator, and even running away from home.

Social / interpersonal impairments are those that address a client’s destructive, chaotic, or unmanageable chaotic world.  These impairments may include manipulativeness, uncommunicativeness, egocentricity, or oppositionalism.

Future / achievement impairments refer to a client’s ability to hope and plan for the future.  These impairments include hopelessness, inadequate survival or health care skills, and educational performance deficits.

Some managed care companies refer to this list of impairments as a Patient Impairment Profile or PIP.  When I have worked with managed care in the past, I have used the PIP to structure my reviews and negotiations for authorization of care. It is an efficient and professional way to address your concerns in the language that best reflects managed care’s concerns.

Here are some recommendations for you to consider when communicating with professionals within the managed care industry about your clients.

  • Do not provide a lengthy problem list of every concern that you have.
  • Do provide a list of impairments that you intend to successfully treat.
  • Start with biopsychological impairments because they carry the most weight with managed care.
  • Impairments should be consistent with DSM-IV symptomology.
  • Include any impairment that has the potential to directly impact treatment.
  • Avoid the use of Axis II diagnoses and V codes whenever possible.

In the world of managed care, clinical / medical necessity is defined by these impairments. It’s important for you to know that by the industry standards of managed care, impairments  (and not diagnoses) are the reasons that a client requires treatment. And, it is impairments that are used to determine reimbursements for your fees.  You will not foster good will or bridge the culture gaps with managed care by addressing clinical “issues” that do not easily lend themselves to your treatment or repair. Keep this in mind when you are going back to them to request extending their authorization for your client to continue working with you.

If you are finding this post useful, let me know and I’ll share a bit more with you about working with managed care.  And, if I don’t hear from you, I’ll happily revert back to my managed-care free emphasis in this blog!


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How To Get On Insurance Panels As A Preferred Provider – Part 3

Oct
10
2011
by Tamara Suttle

This is the third of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. The series began here.How to Get on Insurance Panels - Part 3

If you’ve already engaged in the double-jointed, back-bending, hoop-jumping application process for getting onto insurance panels as a preferred provider only to be told that their panels are “full,” I do have some thoughts to share with you.  Although I no longer work directly with managed care, I know of a couple of ways you might be able to attract their attention in a positive way.

If your application is denied, you can ask for a “single case agreement” when appropriate. If you are able to justify to an insurance company why a client of yours should be allowed to continue working with you even though you are out of network, it is entirely possible for them to grant you a “single case agreement” to be considered “in network” for only that client.

Reasons that might justify such an agreement would be those that address the unique needs of your client and the cost / benefit needs of the insurance company. Perhaps your client has minimal skills in maintaining relationships.  If trust comes hard to her, your relationship with her may qualify as a positive and extenuating circumstance.  Or, if your client is mid- gender reassignment and there are no other professionals appropriately trained to address this client’s immediate needs, you may be the only logical choice.  These are only two examples of hundreds that are likely to exist.  Keep your eyes open and ask.  It costs you very little if you are sure that you want to be on a particular panel of preferred providers.

Then, if the insurance company is pleased with your work, it is also possible for them to easily transition you to being one of their preferred providers.  It’s a matter of massaging those warm relationships with Provider Relations as you go and proving your worth to them.  Remember, it’s much less expensive for the insurance company at that point to add you to their provider list list than it is to begin the credentialing process all over again with a different therapist whose work is unknown to them.

If your application is denied, a different strategy might be to affiliate with another provider who has already been accepted as a preferred provider. Insurance companies prefer to work with groups – even when the individuals in those groups are only loosely affiliated with each other.  By affiliating with a group of providers or an individual provider who has been accepted onto an insurance panel, you are increasing the perception of your value to those same managed care companies.

And, finally, it’s important to remember that the needs of managed care change. Stay abreast of those changes by monitoring on a regular basis the individual companies that you are most interested in. Put them on your calendar to contact every few months.  Give Provider Relations a call, show up at the local Employee Assistance Professionals Association to meet and get to know them.  Most of all, keep your name and face in front of them and let them know that you are eager to join and support them!

And, if you have additional suggestions for getting onto preferred provider lists after initially being rejected, please leave them below!

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How To Get On Insurance Panels As A Preferred Provider – Part 2

Oct
6
2011
by Tamara Suttle

This is the second of a 3-part series to help ease your way to getting approved as a preferred provider with insurance companies. The series began here.How to Get on Insurance Panels - Part 2

Managed care companies receive hundreds of applications from licensed mental health professionals every year who are wanting to become preferred providers.  That’s why it’s important to make your application stand out in a positive way to the professionals in Provider Relations that will be evaluating your credentials and experience.  Here’s a few tips that I’ve learned over the years that may help you rise to the top of the pile.

Tip #1 – Focus on your own efficiency and your ability to save on costs. Managed care came into existence as a reaction to offset the rampant financial abuses in health care.  As such, the primary goal of these companies is to reduce costs of health care.  The care of clients comes second. Make sure that your application speaks to managed care’s concerns and not just your own.

Tip #2 – Location makes a difference. (And, not just for the reasons I stated here.) If you can provide services in an under-served area, you are more likely to be admitted to a preferred provider list.  If you currently provide services in a therapist-saturated market, you may want to consider adding a second site to your practice.  By indicating that you are available to provide services in an under-served area for just a few hours each week, you make yourself much more desirable to managed care companies.  (And, the good news is that once your are “in” on the panel, you can typically relocate your services without losing your place on the provider lists – even across state lines!)

Tip #3 – Highlight second languages that you are fluent in. Your unique expertise is what will get you on the list so don’t forget to highlight an ability to speak a foreign language every chance you get.

Tip #4 – Special hours can set your practice apart. Most therapists work 8 a.m. – 5 p.m.  If you can offer late or early hours or are willing to work on weekends, mention them on your application. Those “special” hours can be a way to expedite your entrance into the world of preferred providers.

Tip #5 – Special populations require special knowledge. Don’t indicate that you “work with everybody.”  That’s not what managed care is looking for.  Instead, if you have advanced training and experience working with a specific population or two, emphasize this. Populations such as geriatrics, children, GLBT, deaf clients, etc. can open doors for you with managed care.

Tip #6 – Advanced training and credentials count. Although experience definitely counts, proof of skills via advanced training and credentialing make you much less of a risk to insurance companies and much more desirable to them, too.  Track your professional development and flaunt it in your application.

Do you have other tips that can help other licensed mental health professionals get on insurance panels?  If so, I hope you will leave them below.

And, on Monday, I’ll wrap up this series by sharing a couple of thoughts for those who have had their applications denied. 


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