A Costly Mistake That Could Have Been Avoided

Make Sure You Get Paid For Your Sessions!

One of the things that therapists fear the most about insurance is not getting paid for all of their hard work. You know what I mean, working session after session, helping a client work through painful issues only to have their claims denied by the insurance company. Then trying to recoup their money by asking the client to pay out of pocket for the sessions and never receiving a dime.

How do I know? Because this has happened recently to a friend of mine. She thought she did everything right only to find out that she had missed something. And this thing she missed turned into a costly mistake.

Here’s what happened... She called the insurance company and verified benefits. Everything looked like a go. After seeing the patient for several sessions, a claim was submitted and denied. 

The therapist was convinced this was an error. She informed the patient, but they decided to keep meeting for therapy. After several more sessions and another round of claims that were rejected, the therapist sought help and asked me why the claims were rejected. 

After looking at the claim, I was able to determine what the problem was right away. The patient's date of birth put her over the age of 65. This immediately told me that she was a medicare patient and I already knew the therapist was not a medicare provider.

You see, the therapist has an LCPC license and medicare does not allow LCPC or LPC to bill medicare for patient services.

After I informed the therapist about this, she was not convinced this was the problem because she verified the benefits with the insurance company and the therapist was on panel with that insurance. 

What she did not realize was that medicare uses other commercial insurance companies as an alternative to original medicare. Sometimes these plans are referred to as part C or MA plans and are medicare approved commercial insurance. 

So, it’s possible that AARP, UnitedHealthCare, or Humana (just to name a few) are the insurance companies that are covering the cost and reimbursement of claims. Meaning that the insurance card will look similar to those of regular commercial insurance. And if you are a provider for those insurance companies, it might look like you could see those patients just like you would your other patients.

So, what's the problem? you might ask. The problem is that these advantage plans must follow all of the same rules that medicare follows. If you are not eligible to be a medicare provider, you will not be reimbursed for services. And this is what happened to my friend. 

She mistakenly thought that just because she was a UHC provider, she would be reimbursed for claims. However, she is an LCPC and they are not eligible to be providers for medicare. That’s why her claim was rejected. 

I am sure you can imagine how upsetting and disappointing this could be. The patient was also upset because she thought her sessions were covered by insurance. The patient blamed the therapists for not knowing the sessions would not be covered. 

Don’t let this happen to you. By understanding the rules of medicare, all of this could have been avoided. How, you might ask.

By looking at the date of birth. If the client’s date of birth puts them at 65 or older, they most likely have medicare or a medicare advantage plan.

Make sure you get a copy of the insurance card (don’t just ask for the ID number and call it a day). There is a lot of very important information on the insurance card itself. Looking carefully at the insurance card will tell you if it is a medicare plan. 

I hope this helps you avoid making these types of costly mistakes. After all, we work really hard to help our patients and we should be compensated for all the work we do. 

As a Psychologist with a thriving business, I believe that owning an insurance based private practice is the key to financial freedom, professional freedom, and personal freedom. If you liked this information, join my free facebook group Wealthy Therapists Take Insurance for more tips and strategies. If you have questions or need help creating your own practice, contact me at Robin@DrRobinMyers.com. I offer Coaching and Consulting Services.