Taking on Private Insurance is Like Learning to Eat Healthy

Taking on private insurance is like learning to eat healthy.

At first you aren’t sure you want to do it. You’ve heard how hard it can be and so you’re on the fence. You enjoy your freedom and don’t want to be tied down by all the rules. It seems like so much effort. It feels too hard.

But there’s this little voice in the back of your mind saying what if? What if eating healthy could be the best thing for you in the long run? So you take the first steps in learning to eat well. You find yourself frustrated with the effort, energy, and resulting mood swings that come from being outside your comfort zone. You continue to question if it is worth all the hassle. You have a couple meltdowns.

Eventually, with persistence, you find your groove. You’re noticing it takes less effort to eat healthy. You’ve found success in having a plan in place, it feels more effortless now. 

The journey of adding insurance to your private practice is a lot like learning to eat healthy. 

The same emotional rollercoaster. The same doubts and frustration. The same growing pains. And in the end, insurance can contribute to the overall health and well-being of your business, allowing it to thrive amidst COVID-19 and beyond.

 So let’s take a look at some of the myths and practical tips to navigating insurance in private practice.

Myth #1: The Panels are Closed

It’s possible that the panels are closed, especially when we understand that insurance data on their providers isn’t very accurate or up to date. It isn’t uncommon to hear that providers listed in directories are retired, deceased, or not taking new clients. So how successful would a member (client) be in finding a qualified provider?  Encourage potential clients to reach out to their private insurance to express their concerns and difficulties. Sometimes this works to open up a panel for credentialing of additional providers in hearing that their members can’t find the services they need.

What can you do as a professional? 

·      Name your Niche: Highlight your specialties and justification for being approved as a provider. If insurance finds you are providing a service their members want, they could agree to move forward with credentialing.

·      Be Persistent: Follow up with closed panels to see if things change over time. Your persistence may pay off if you catch them in the optimal window where they are taking new providers!

Myth #2: Payment is Poor

I recommend to fellow providers that we all find a way to make peace with not being paid what we are worth. Insurance panels will report that they generate their pay structure based on comparable professionals in your area and thus, believe they are offering a competitive rate. Regardless of what they pay, is it still important to you to serve a particular population? Is it worth the effort to help people who need to use their insurance to access services? If you’ve answered yes to these questions, don’t give up on insurance just yet! Panels continue to evaluate rate of pay on an annual basis and I’ve seen the rates of reimbursement improve over time. There’s hope that they will continue to evaluate and increase rates every year.

Professional Pointers

·      Do your Research: What services does each insurance panel reimburse for and at what rate? Interview colleagues to better understand their experiences with certain panels.

·      Renegotiate as Needed: Identify the process for renegotiating your rates once you’ve been credentialed as a provider. It doesn’t mean you will automatically get what you’re asking for but it could spur insurance to take another look at rates for all their providers in hearing from you and others that a rate increase is desired.

 Myth #3: Billing is Unbearable

I agree with you that billing can be a headache. More so when we had to mail in claims or submit them by hand on CMS1500 forms. The good news is that billing has been streamlined, saving time and headaches for providers everywhere! What has streamlined billing over the past ten years? Electronic Health Records (EHR). Popular options like SimplePractice, TherapyPartner, and TherapyNotes have billing processes built in, eliminating the middleman clearing house and auto-filling some billing information based on your calendar appointments to save you both time and effort as a busy clinician.

Professional Pointers

·      Create Templates: Streamline your process even further by creating required templates in your EHR like a credit card form for collecting copays and a Mental Health Assessment to justify a clinical diagnosis required to bill each service.

·      Understand Compliance: Identify compliance requirements based on your insurance contract. Most require a diagnosis resulting from a formal intake, progress notes, and treatment plans for providers to remain compliant and pass an audit.

Myth #4: I’ll End Up Working for Free

There is understandable fear that clinicians could work for free. Insurance panels could take money back if providers make a billing error or if the member isn’t actually covered by an active insurance policy at the time of service. Combine this with confusion about what insurance plan the member/client actually has and the random names for varying plans under bigger names like Aetna and United, it’s no wonder providers feel reluctant to jump on the insurance bandwagon. It’s in your best interest to create a system and process for verifying insurance from the first contact with a client you’d like to work with. It is also in your best interest to bill regularly so you can catch any errors in a timely fashion. After all, it’s even more painful to realize you aren’t getting paid for the last three months in having waited to bill sessions at a later date. 

Professional Pointers

·      Anticipate Delays: Budget your business with anticipation of delays in payment. Most insurances take 2-3 weeks to process claims.

·      Set up EFT: Selecting Electronic File Transfer (EFT) or Direct Deposit of funds will save you some stress in seeing when funds are processed and received in your business account

Insurance doesn’t have to be so stressful. I sincerely and passionately believe that adding insurance clients to your practice will support sustainability and quality client referrals, making your business a healthy one full of growth and long-term potential in offering what you do. 

To learn more about adding insurance to your private practice, check out our webinar, Investing in Insurance: Strategies for Private Practice which features more on the 4 Myths and 20+ Tips of adding insurance to your private practice, making it work well for you!

Failure to Launch: Fostering Confidence and Freedom

You may recall the American Romantic Comedy “Failure to Launch” in 2006 that describes a 30-something man struggling to leave the nest. This concept isn’t foreign when describing young adults’ struggle with achieving the next milestone of independence: moving out of their parents’ house. Dr. Jean Twenge writes extensively on the trends of stagnation and delayed pursuit of independence in both the Millennial and iGen generations.  But what can we do to support confidence and the pursuit of autonomy and freedom in our young adults?

An Uphill Battle

For many young adults, American society has given them expectations that they can do anything they want, be anything they want, follow their dreams, and thus, never settle for mediocre in their identity, career, or relationships. For the adult child, this becomes a rude awakening when facing competitive college admissions, fighting for quality jobs, and budgeting to live on their own with the rising cost of living. Dr. Twenge speaks extensively about the ways young adults are set up to fail—highlighting loneliness, a lack of self-esteem, and elevated anxiety and depression as some of the challenges of our 18-35-year-olds.

Recognizing that these challenges may lead to stagnation and loss of confidence, it is important to foster hope for these generations, both in themselves and the communities they cultivate that can help them achieve success. Below are some ideas for young adults to support their transition to independence from their parent’s home:

1. Identify communities of support-By finding and strengthening connection to communities that feel like-minded and relatable, you can shift from family of origin focus to relating to others and developing other spheres of connection outside the home.

2. Explore other's experience-Knowing that you are not alone in how you feel and the struggles you face can make the transition less lonely and more hopeful by learning form other’s experience and strategizing your next move.

3. Build confidence-Engage in self-discovery by identifying areas where you have strengths. Identify what’s most important to you through values exercises at Lifevaluesinventory.org and explore career strengths and direction at youscience.com.

4. Positive reframes-Practicing your ability to rewrite negative thoughts or experiences can be a powerful tool in creating confidence and hope of independence. Reframing negative thoughts as temporary or your best effort can inspire movement and hope. To learn more, consider individual therapy where a professional can teach you these skills through Cognitive-Behavioral Therapy or identify a gratitude practice that can shift negative thoughts daily.

Parenting Parameters

Fostering hope and confidence is not exclusively the job of professionals. The support of parents can also be crucial to the confidence of a young adult. Here are some ideas for parents to encourage the exit from the nest:

1. Support structure-parents’ ability to provide rules and expectations in the home can be an important incentive for young adults to exit and live on their own. When we think of the movie “Failure to Launch,” the parents made it too easy and convenient to stay in the home, thus stifling any urge in their son to leave. Structure can support expectations of a young adult’s transition from the house in a supportive way.

2. Remain consistent-being consistent and true to your word as a parent is just as important now as it was when your young adult was a child. Predictability can support your young adult in building respect for your position in their exit from the home by identifying a timeline for your young adult to move towards independence and freedom.

3. Provide encouragement-with change comes anxiety. Remember to be encouraging, positive, and reassuring towards your young adult that you are still a part of their lives and care about them as they make this transition. This will allow them to feel comfort rather than anxiety or grief at the loss of daily contact and connection offered in your household.

In whatever ways one accesses the confidence to pursue independence, knowing there are loving, caring connections between the person and others is a vital component of their success. There is no rule book for how to move from failure to launch to thriving in freedom. In a generation that feels more lonely and anxious than ever, community connection and meaningful interactions can help. We can support the next generations in their success though encouragement and kindness, and in this effort, we all win.

 “Change is hardest at the beginning, messiest in the middle, and best at the end.” Robin Sharma

Mandatory: Making it Worthwhile

“I don’t want to be here. I’m not going to say anything. I don’t know. Why should I talk to you?” You may find yourself thinking or saying thoughts like these in response to pressures to engage from a program, family, or friends. Perhaps you aren’t ready to share what’s brought you here, or what the challenges are that you are facing in this moment. Perhaps you feel like your personal freedom has been taken away, your choice to participate of your own free will. Understanding that you may feel angry, resentful, or withdrawn, please consider the following in support of getting the most out of something that is identified as mandatory.

Blocking or Belonging

You may come from a different background or hold different values from those you come into contact with, so what brings people together in this process? Shared experience around homelessness, financial instability, substance abuse, conflict in relationships, or a lack support can help one feel less isolated and alone in their experience. Although each person’s story is their own, the feeling of connection to others and belonging can go a long way in having an experience feel less mandatory and more voluntary. When you observe others engaging in the program or group, you may find yourself asking:

• Do I feel I can relate to others in the group?

• Do I feel this community is healthy, approachable, supportive, and willing to engage me in this process?

• Do I feel supported by staff and helping professionals to achieve my goals?

• Do I feel comfortable opening up and working on myself in the presence of others?

For many involved in Alcoholics Anonymous (AA), they speak of the community as an equally powerful element as the 12 Steps in to their ability to actively participate in their own sobriety. Due to the friendships they make, they feel they have a connection to others in ways that feel encouraging and uplifting in moments of challenge or struggle.

Building Perspective

In addition to identifying a supportive community, how you approach the experience for yourself matters. Do you have realistic expectations of what you can accomplish both short and long term? Can you set yourself up for success in your work with others? When starting this process, it is helpful to understand basic needs as the foundation for progress. Educating yourself on how basic needs such as food, safety, and shelter provide the foundation of stability gives you permission to organize goals for success. Abraham Maslow, who identified this relationship in the Maslow Hierarchy of Needs, emphasizes that only when basic needs are met can one focus on higher work around self-esteem, sobriety, and relationships.

Relational Rapport

When exploring relationships, research tells us that therapeutic rapport accounts for more than any other factor when measuring progress towards goals set in therapy. In other words, the therapeutic relationship, unconditional positive regard, and power of feeling seen, heard, understood, and supported has positive results on goal progression. If your past experience involves trust or mistrust, being aware of how therapy and/or relationships have helped or hindered you in the past can put current resistance and reluctance in perspective. A few questions that you may find helpful at ask at the first meeting with a helping professional include:

• What kinds of clients have you worked with before?

• How do you work with people who are uncomfortable with therapy?

• What do you do with feedback from clients?

• What can I expect from working with you?

All of these questions encourage healthy discussion around the therapeutic process and can provide insight into expectations and measurable goals when engaging a helping professional in your own growth process. 

Mandatory can feel restrictive and stressful when viewed as a loss of control or freedom. What better way to reframe it than to ask yourself, what can make it worthwhile? 

“If you change the way you look at things, the things you look at change.” Dr. Wayne Dyer