This Year, Get Paid Every Dollar: 10 New Year Tips
By Barbara Griswold, LMFT January 2, 2024
Maybe you aren’t one to make a list of New Year’s Resolutions. But this year, how about making a resolution you can actually keep: to start the New Year right when it comes to your business.
If you work with insurance, you know there is a lot you can’t control. But sometimes our own bad financial habits lead to rejected claims and loss of income. So, in-network therapists — let’s start this new year off right, and resolve to collect every dollar we are owed for insurance clients!
- Ask all your clients about known changes in insurance coverage effective January 1st.
- But don’t trust clients. I know that sounds harsh, but often clients are not aware of changes in their insurance plan, copayments or deductible, which can mean you may not get paid at all.
- Get a copy of their latest insurance card, front and back, even if your client doesn’t think there have been changes. Clients can take a picture of both sides of their card and email or text it to you.
- Call the plan for each insurance client, and do it now (be sure to have the client’s date of birth handy). Time consuming? Absolutely. But absolutely worth it to avoid costly denials and headaches down the line. You may find the client isn’t covered in the new year. Or you may need to request new treatment authorizations for clients before you see them. Most importantly, you need to find out if the client has a deductible, which can mean a sudden stop in health plan payments until it is used up.
- What if they have a deductible? The deductible is the annual amount that many plans require the client to pay out of pocket before the plan begins to pay. Often thousands of dollars, the deductible restarts each January for most plans (though be sure to ask!). So, if a client has a deductible with a January restart, the first sessions of the year must be paid in full directly to you by the client — the health plan will not cover these.But be sure to charge your client only your contracted rate with the health plan for each session during the deductible period, not your regular fee. You still need to bill the plan, even though they won’t pay and the client is paying directly — this way, the deductible will be whittled away.
- What else should you ask when you call? See the worksheet “13 Essential Questions: Checking Coverage” in my insurance book (available at at our online store). These questions include asking about copayments, deductibles, claim address for mental health, telehealth coverage, whether the services you are providing (and your license) are covered, and others you might not have thought to ask. Don’t trust the insurance card, as the info on the card often does not apply to mental health.
- Submit your claims early. I submit claims for January after the client’s first session so that I can find out earlier about the new year’s eligibility and coverage problems.
- Review client balances from last year.Did you bill insurance for each session from last year, and have you been paid for each visit, both by the client and health plan?
- Go over the list of insurance plans you work with.Carefully consider if it makes good financial sense for you to continue with each plan in the coming year. Consider asking for a reimbursement rate increase from all plans (see my article on raises).
- Set a new, stricter claim submission routine for the coming year,and add reminders to your calendar so it becomes a lovely new habit. I submit on the 16th of the month for sessions between the 1st to the 15th of the month, and at the end of the month for the 16th to month’s end. Daily or weekly is even better.