OK, let’s say you curse the low reimbursement rate of your insurance contract (right?) plus you wish you could sidestep billing for insurance clients. But you know that when a client comes to you from a plan you participate with, you agreed in your contract to give that client the reduced rate and to take care of billing. So, this begs the question: Are there ethical ways to bypass this contract?

One option: Offer a service to these clients that is not covered by their insurance. Perhaps a service that is not therapy, or not considered medically necessary by the plan.

Most insurance plans will only pay therapists to provide psychotherapy, and only will pay when a diagnosis exists.  Plans typically will not cover services that are deemed not therapeutic, that might be considered preventative, supportive, or educational.

So, if you are looking for ways to generate private pay income, and services you could provide that would bypass your contract, you might consider providing a support group or class. What’s the difference between an anger management therapy group vs. a support group or class?  In addition to the different clinical role you would play, when offering therapy you need to assess each group member to see if a diagnosis exists, and if so, you’d have to bill insurance when you are a network provider. This would typically limit your fees, whereas a support group or class — where no diagnosis is being treated and no medical necessity for treatment exists — could be private pay.  In addition, the support group or class would also have the benefit of not requiring treatment plans and progress notes for each member, and you wouldn’t have to deal with possible clinical reviews or audits. You might also be able to provide these services more easily across state lines, since non-therapy services would be less regulated.

Now that we are thinking outside the box — or outside the contract — what other options can you come up with? How about providing counseling where there is no distress being reported, such as sessions focused on pre-marital compatibility, planning and support for happy pregnant couples, or communication skill-building sessions for those in non-distressed relationships?

How about leading a multi-hour retreat? Maybe an all-day intensive?  Even if these are therapy focused, insurance often won’t cover these due to their length. Check with the health plans you work with — if they usually cover only one hour of therapy a day, you may be able to bill the client’s health plan for the first hour and bill the client for the rest of the time. But the focus may not be therapy — it could be more support or educationally focused.

Even wonderful trainings like Mindfulness classes or CBT or DBT skills trainings for clients are not typically covered by insurance if they are in a class format. Teaching clients these useful skills can be a second source of income for you — one that your insurance contract shouldn’t be able to touch.

Just be sure to tell clients clearly up front that you are not providing therapy, and in your  advertising and paperwork be sure you are clear it is not therapy, and that it will not be billed to their insurance.

Also, don’t just provide therapy but call it something else in order to get out from under the constraints of your insurance contract. If a client comes to you in distress and seeks therapy, and s/he is a member of a plan where you are in-network, is is important (and ethical) that you offer the client the benefit of your contract with their plan, when appropriate (see my article on Converting Insurance Clients into Private Pay Clients — click here).