FEEDBACK: Answers to your questions about turning down insurance clients
QUESTION: “I’ve been accepted as a provider for Blue Cross/Blue Shield. But I’d like to limit the number of insurance clients I take. Is it OK to selectively tell potential clients that I’m not taking their insurance?”
ANSWER: Well, people do it all the time, of course. But is it technically a violation? That depends upon your contract. You can usually tell a payor that you’re booked up--sometimes online. (Magellan, for one, offers this option.) Then you can tell them when you’re ready to take new patients again.
But you should be careful how you do it, warns Jean Thoensen, a mental health care biller and consultant in Centreville, VA. You can’t tell the company that you’re taking new patients one day, say no the next, then say yes again the day after.
This issue comes up a lot with Blues plans, Thoensen says. In many areas, their reimbursement has remained relatively high, and some providers have come to depend on them. But a sudden drop to more typical managed care reimbursement will make clinicians yelp. “Instead of charging $120 an hour,” notes Thoensen, “all of a sudden they’re getting $65.”
“What some people do--and I don’t like this--they will offer only the really unattractive, inconvenient time slots to the patients they don’t want. They may say ‘I only have 2:00 in the afternoon, knowing full well it’s unlikely someone can take off work.’”
This isn’t specifically addressed in most contracts--but some companies do make a point to cover it.
Thomas Hartsell, an attorney who works with mental health professionals in Dallas, says that provisions restricting a clinician’s ability to opt out aren’t uncommon. He says some contracts specify that you can refer clients back to the MCO to find another therapist--but that can raise other issues.
“That works fine as long as there is someone on the panel who is competent to treat the client’s problem. But what if there isn’t such a person in their area? In my view the therapist has a duty to refer the client to someone who is capable of treating the problem.”
Contacts: 1) Thomas Hartsell, 850 Central Parkway East, Ste. 230, Plano, TX 75074, email: firstname.lastname@example.org; 2) Jean Thoensen, PsychBiller, P.O. Box 2029, Centreville, VA 20122, (703)266-8612, email: email@example.com.