From Your Billing Pro

July 14, 2014 Neisha Zaffuto

 photo fromyourbillingimage_zps6f0262e5.jpgAssessing Private Insurance Reimbursements


Q. Is Private Insurance Reimbursement Worth It?

A.   Some insurance companies pay poorly, but many pay quite well. Usually the larger private insurance companies: Aetna, Blue Cross, Blue Shield, and United Behavioral Health (and many more) pay the best. In general, Medicaid and Medicare reimburse lower than the private insurances.  Regardless of the reimbursement rate, it’s important to stick to the time limit provided in a service’s CPT code. For example, if you are billing for a 45-minute psychotherapy session, any time spent with clients after 45 minutes is free labor. Those 15-minute overages add up!

Q. Can I bill the same client for multiple sessions in one day?

A.  Without special permissions, the rule is normally one session, per patient, per day. However, if you call the insurance company, you may be able to receive authorization for more than one service per day.

Q. How long do insurance payouts normally take?

A. Typically, it can take 30 business days from the date the insurance company received the claim until the reimbursement is received. But it does not always take that long. For example Aetna normally takes three weeks.

Q. Can I bill a client for the balance?

A.  If you are contracted with a particular insurance company, you cannot “balance bill” your clients. You will have to accept the insurances’ rate, and then write off the difference, for that particular service. If you are out of network and do not have a contract with an insurance company, then you can bill the patient for the remainder. But if you have a contract, you are contractually bound and cannot go over what they allow for that particular service.

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