Why Insurance Billing is Like a Wedding: For every therapist who provides a super bill

Do you provide a super bill to your clients so they can be reimbursed by their insurance company after they pay you? 

You may think because you choose not to contract with insurance yourself that your client's records are protected. Well, that's only partly true. 

You see, when clients choose to allow their insurance company to pay for their counseling they are entering into a "deal" with the insurance company. They're essentially letting the insurance company call some of the shots related to their treatment. 

What does this look like? Well, that depends on lots of things but mainly on the insurance company and your client's plan. 

To give you a real world picture of how this plays out, let's look at this common wedding scenario:

Your parents offer to pay for the reception at your wedding. This is quite a large expense and you're very appreciative. In fact, you may not even have a reception if they weren't willing to pay. You graciously accept their offer and begin planning.

Things are going well. Your mother helped you choose the food and it's going to be delicious. You sit down with her one weekend to plan out the seating arrangements... and things take a turn. She has a different idea about the priorities and order of seating.

You may argue for a bit but in the back of your mind you know: she paid for this. Can you really just tell her no? How much say does she get? 

And think of the mother's argument for a minute... she has invested all of this money, very willingly. But she wants to make sure this expensive event will be "all that it could be." She may understand some dynamics the bride is unaware of or may have thought differently about her level of input from the very beginning. 

Insurance companies are similar in that they have a vested interest in your client's therapy. To put it frankly, they are "footing the bill" and they want to make sure they are getting their money's worth

Keep in mind this isn't necessarily a negative thing. If your client understands this process, is fine with it, and using insurance makes therapy more easily accessible to them, GREAT! 

But if your client doesn't understand that there are certain rules to follow and no guarantees about ongoing payment, this can be quite a shock. And it's my belief that it is your job to tell the client about this scenario.

You may be thinking, "but that's exactly why I choose to do the super bill thing rather than have a contract with insurance companies, so I don't have to think about this stuff!" Totally understood, and you're right. It's not your job to think about all the insurance requirements when you don't even have an insurance contract.

But it is your job to explain the limits of confidentiality. And as soon as you choose to provide that super bill, I believe it's your ethical duty to explain to your clients the realistic expectations to have with insurance, reimbursement and confidentiality. 

It doesn't have to be a long conversation! And you can phrase it many different ways... but yes, I do have some tips for what you can say... or you can just steal my wedding scenario.

  • Explain that insurance may limit things such as how much they're willing to pay per session or how many sessions for which they'll approve payment. Discuss what this means for the client as far as out of pocket expenses and expectations. 
  • Explain that once insurance is paying for something they have the right to follow up and see how things are going. This is typically either via phone or records request. 
  • Make sure clients understand if they choose not to allow records to be released when requested, insurance may choose not to pay for those services.
  • Inform your clients that any super bill or anything submitted to insurance related to payment will require a diagnosis. Discuss with them possible ramifications of this (like implications for life insurance coverage). Also let them know what their diagnosis will be, why and insure they understand that piece. Note: It is considered insurance fraud to inaccurately diagnose a client in order for them to obtain coverage. 
  • Stay focused on the part you know. Don't try to guess what the insurance company will or won't cover. Refer the client back to their carrier for questions related to coverage.

For many clients there are very few issues and things run smoothly, requiring little work on your end. But in those circumstances when requests for records or denials of payment come up, it's best to be prepared.

Let us know in the comments below if you have any further tips for explaining to clients the relationship between therapy and insurance. And feel free to share any resources as well. 

I have some on the QA Prep Resources page and you're welcome to ask questions below.