Question: I don’t work with insurance (I guess that makes me an “out-of-network provider.”) After watching your Progress Notes webinar, I learned that when I give a client an invoice to turn into their insurance, the door is open for their insurance plan to review my treatment or even request my notes. I want nothing to do with this – this is unpaid time, and part of why I didn’t join insurance plans! Can I notify clients in my informed consent in advance that I won’t give invoices, or won’t talk to their insurance plan if I’m called?

Answer: “I wouldn’t advise it,” says David Jensen, J.D., a mental health specialty attorney at CTSC Law. Even if the client initially goes along with it, not giving a client an invoice – effectively blocking their ability to seek what may be much-needed insurance reimbursement – could later cause a client to file a complaint with your licensing board or ethics committee.

Alternatively, you could agree to give invoices, but refuse to talk to insurance plans if they call. However, this refusal would likely lead the plan to deny coverage for future sessions, and could lead to a client complaint. Remember that many professional ethics codes require that you advocate on your clients’ behalf with third-party payers to help clients receive the care that they need. “We really have to do what’s in our client’s best interests,” says Jensen.

It may also be helpful when developing these policies to ask yourself how you would feel about these limitations if you were the client.

However, it is important to note that, as an out-of-network provider, “since no contractual obligation exists between you and the insurance plan, you are free to charge the client for any time you spend on the phone with the insurance plan,” says Jensen. Read your provider agreement. “Perhaps out of network therapists should consider thinking more like lawyers and accountants, charging clients a fee per minute for time spent on the phone for treatment reviews” or dealing with records requests. Just be sure these fees are outlined clearly in your informed consent at the start of treatment.