I see that no one has responded to your question, and that may be because the question is a tad confusing. It’s not clear if you are contracted with Medicaid. In order to bill Medicaid in your state, it is my understanding that you must be licensed in the state that you are practicing.

I don’t know what a P-LPC is (I assume you are accumulating hours towards a license and have a limited permit perhaps?). In New York state, no insurance company will reimburse for a therapist with a master’s degree but no license. They will not accept you on their panel until you have a license (you must have a contract with them to be on their panel — they’ll ask during that process if you have a license). Even then, they do not accept ALL master’s level licensed mental health professionals.

If you don’t have a contact, you’d only be able to get reimbursement if you bill as a provider outside of their network, and even then, they’ll insist you be licensed. Medicaid does not pay out of network so I think your supervisor is misinformed.

When in doubt, just call the insurance company and simply ask if they will reimburse you. Medicaid, in New York State, has high requirements and will only reimburse those who have licenses; it used to be that they would reimburse for master’s level clinicians without a license but only in certain institutional settings. That was the case a few years ago, but I think that exemption was eliminated years ago.

In those settings, a clinician would not be doing her own billing anyway and so the question is moot. Usually you’d be employed by those institutions and supervised by their supervisors.

I hope this helps. Every state is different but I wouldn’t ask your supervisor, I’d ask the insurance companies what their requirements are. They’re not likely to pay anyone not licensed.

“You write it off” — in your mind, you mean! Because you are in denial that you work for $75 instead of the e.g. $150 or whatever you would LIKE to work for! If there is no deduction for that income “lost” (because it’s not lost — it was never in play, except in your mind), the phrase “write it off” is really just a metaphor. I work mostly in-network and my fee is what I’ve contracted for. I have learned to accept it. What interests me is that I recently worked with a patient whose former therapist DID charge her “the difference” and told her that the insurance company (one of the biggest) “could never come after me.” I have no idea what that meant, but apparently she does very well charging patients a hefty surcharge “under the table.” However, my patient happened to consult with somebody else who told her that she was being scammed — so she left that greedy therapist!

#2) I have heard that you cannot just take cash from a pt. that has an insurance contract with you, even if the pt. wants to be self-pay. Is this true? What part of the contract do I look at to find out?

Hi Samantha,
Good question! Some insurance companies will only cover 45 minute sessions, others cover 60 minute sessions, others cover 60 minute sessions but pay the exact same rate as 45 minute sessions. Getting coverage for 90 minute sessions for outpatient psychotherapy is exceedingly rare. Additional authorization for longer sessions is sometimes necessary, and sometimes not (again, it completely depends on the company and your contract with them). Clear as mud, right? 😉 Regarding your second question, insurance companies are very secretive about the rates they pay until they issue you a contract to work with them. There may be some pages where people have posted their reimbursement rates from insurance companies, but you’re going to be hard pressed to find anything close to an exhaustive list!

Thank you for all of the clear and useful information you are providing. Here is my question: The break down for billable time as I understand it is 45/60 and 90min sessions. Other than the procedure code is there additional protocol or authorization requirements to bill for longer sessions? If you are working with the client for 60 minutes why not just bill under that code? Also is there information available online that would allow therapists to compare the amount ins. companies payout under their various plans prior to applying? Thanks!

Hello!

1Q.Re: ” You will have to accept the insurances’ rate, and then write off the difference, for that particular service”. –Do you mean write-off of taxes? If so, how does one do that? Is there a limit to what one can write-off?

1A: You write it off as a loss, but there’s no tax break for services not paid for. If it were assets, like stock/goods that you sold and didn’t get paid for, you would be able to write off the cost of the goods (seems kind of unfair, but that’s tax law ;-P)

2Q. Insurances re-emburse for 90834 45 minutes. I spend the fifteen minutes in between sessions either billing or writing notes or both. Can I bill the insurance company for that time, or bill the patient separately for that time, or would that be considered balance billing?

2A: Unfortunately, you can do neither.

2. Insurances re-emburse for 90834 45 minutes. I spend the fifteen minutes in between sessions either billing or writing notes or both. Can I bill the insurance company for that time, or bill the patient separately for that time, or would that be considered balance billing?

Thanks-again, great info on this page.