Every day, therapists contact me with their sad stories about some nightmare they are going through with an insurance plan.

Sometimes the health plan audited their records, and found coding and billing mistakes, or just poor documentation. Sometimes the plan wants them to pay money back. Sometimes a LOT of money. Sometimes a client has complained to the health plan or licensing board about one of the therapist’s billing policies, a policy that actually is not ethical, or is a violation of the therapist’s contract with the health plan.

My heart goes out to them.

The worst part of our conversation for me comes when I hear them say, “well, I asked several other therapists, and they reassured me that was how THEY did it.”

In many cases, the therapist made one crucial mistake that is now costing them a great deal of money. That mistake? Trusting other therapists for authoritative insurance or billing advice.

Often this advice comes from other therapists in Facebook Groups or other online therapist groups.

Not that these online groups don’t have their place (I belong to MANY of them). I don’t know how I could have run my practice without the support, suggestions and referrals I got from these groups. But when it comes to business advice about insurance, coding, billing, documentation and policies (ex. sliding scales), there is often a lot of just plain incorrect information that is shared in these groups. That information is then read and accepted as the truth, and this misinformation then gets passed from colleague to colleague as “the right answer.”

When they turned to their colleague for advice, what kind of questions did they have?

• “I can bill an insurance client my full fee if they no-show, right?”
• “During the deductible period, I don’t submit claims to the plan since they won’t get paid, right?”
• “I can code ongoing couples sessions as CPT code 90837, as long as my notes focus on one client, right?”
• “I can limit new insurance clients by saying I can only see them if they pay out of pocket, right?”
• “I don’t need to opt out of Medicare – I can just see a Medicare client in my private practice, right?”
• “I can waive a client’s copayment, right?”
• “Sliding scale fees are unethical, right?”
• “I can see a client who travels to any state where I’m not licensed, as long as they reside in my state, or it is only a one-time visit, right?”
• “I only have to put one of the client’s diagnoses on the claim form, right?”
• “If a client has two insurance plans, they can choose which to bill, right?”

[Answers at the end of the article]

So, why is turning to a colleague for serious advice problematic? Colleagues should not be confused with experts. Unfortunately, like you, they likely didn’t get any training in business, including insurance billing and coding. And like you they likely didn’t get much training in developing ethical business policies. Finally, chances are that the colleague you are talking to hasn’t been keeping up with the latest coding updates, documentation requirements, regulations, or new laws, like experts do.

When we seek advice about a very important matter from a colleague, it is essential to remember that no matter how confident they sound, chances are that THAT colleague may be doing it wrong, and that they got their information from a supervisor or colleague or online source who was doing it wrong also. Therefore, what we have is bad information being passed down through generations of therapists, only making it seem more valid by the sheer number of people who are supporting the incorrect practice.

So please – when you have a serious business question, and getting the RIGHT answer matters, I hate to say it, but beware of trusting your colleagues. It could cost you a great deal of distress – and money. Instead:

• Contact a specialist in the area of your question. Take the time and spend the money to invest in getting business support. Since I am “mostly-retired” and no longer offer consultations , I have put together a FREE Practice Coaching Resource List of some private practice coaches, group practice coaches, and experts on documentation, billing, HIPAA, legal concerns, and other business issues, available here. Join their email lists so you can stay up to date on changes that will affect your practice
• Join a professional association. They often have reputable online articles that you can usually trust. Many have on-staff attorneys you can consult with, even for general best-practice policies and ethical issues.
• If it is a legal issue, contact your malpractice carrier to see if they provide free legal advice. Or hire an attorney who specializes in mental health issues. Or again, check with your professional association.
• If it is a coding or billing issue, seek out a professional biller or specialist in billing (see my list).
• Check out my website Articles page, and my online store for trainings and my book which will answer lots of your questions about billing, documentation, audits, and the business of private practice.
• If you DO use the internet (which I use every day for research), choose only articles from trusted sources, like the APA, other professional associations, and the sites of experts on my Resource List.

By the way, the answers to ALL  the questions above is “wrong.” If you answered any questions incorrectly, perhaps you should consult an expert!