The team at Thriveworks just completed a lot of investigation to try and determine that the reimbursement rates for Keystone Mercy (a major insurance plan in Philadelphia, PA) is paying counselors. We were shocked how difficult it was to get a clear answer, and even more shocked at how LOW the reimbursement rates are for masters-level counselors.
Their rate is a dismal $26 for a 45-minute psychotherapy session.
How any provider can afford to run a practice and accept rates this low baffles me. We often defend that most insurance companies pay fair to well. However, this insurance company may not be worth your time! After insurance credentialing and medical billing costs, not to mention one’s time and general overhead costs, there is very little (if any) financial upside for counselors, seeing clients with Keystone Mercy Insurance.
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Anthony Centore
This underpayment trend is getting worse with companies like Multiplan renting networks to insurers. They will find the lowest contracted rate of any negotiated provider agreement, and then try to tempt counselors into accepting these low rates in exchange for expedited payments. There is collusion among insurers to set unreasonably low rates, claiming they are based on reasonable & customary data. But ask them how they determine those rates, and you will find secrecy.
you fail to mention that this organization is a Managed Medicaid organization. It is not a commercial insurance organzition there for is regulated by the Pennsylvania Medicaid Fee Schedule.
Indeed, thanks for contributing that! You are correct to mention that Keystone is not a private insurance company, but Pennsylvania Medicaid.