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Payment reminder letter to client for Planning

hi everyone welcome to this askabiller seminar understanding reimbursement raises and resigning my name is avery i've been working in the healthcare industry for three years actually at simple practice and just after spending a bunch of time working with clinicians and you know their insurance situations and everything it just became extremely apparent to me how important understanding insurance is because it plays such a huge role in everybody getting help and everything so i'm feeling pretty good being able to be helping host this webinar and uh kind of disseminating information out there to people who might need it um and then you know the woman of the hour uh barbara griswold she's a practice consultant and the author of navigating the insurance maze right now it's in its eighth edition so go and check that out she just celebrated 30 years in private practice and her goal is to help therapists feel as confident about their businesses as they do about their therapy so she invites you to her website the insurance maze.com where you can ask her questions i'm just going to mention the fact that these ask a biller videos is a whole series of them you can go to simplepractice.com ask a biller series to go ahead and view them all all you have to do is type in your email and all those little locks down there that you see on some of those will disappear and you can go ahead and view them all so if there are any particular topics you want to go over and get a little bit more information about you can go check that out and watch them so now just to get to some questions here so the first thing we're going to touch on here is reimbursement first question from sandy l is i charged the insurance plan a hundred and fifty dollars for a session but on the explanation of benefits it listed one hundred dollars as the allowed amount what is an allowed amount right right so i want to start out with this question because you know well first of all i divided all the questions into three sections we've got talking about we're going to be talking about reimbursement rates just kind of in general your questions about that then we'll talk about raises which i know is a big question for us and then about resigning so just to kind of let you know that there's three sections here so the allowed amount what is that it really depends if you're an in network provider or an out of network provider and let's be clear what those are network provider means you've signed up with an insurance plan you signed a contract and you're submitting claims for that for those clients of that plan and you are offering a discounted rate and all that stuff so out of network is anyone who has never signed a contract with that particular insurance plan you are automatically an out-of-network provider you don't need to do anything so the allowed amount means different things if you're a network provider basically it's your contracted rate the the rate that you agreed to when you signed up with that plan to accept so if i'm charging 150 as as is in this example and they come back and they say well a hundred dollars is your allowed amount basically what they're saying is hey you can build for 150 but the the contracted rate that we have between us is a hundred dollars and that's what we're going to go based on we're not going to allow your full 150 if you're out of network and you've built your client has paid you the 150 up front and you give them a super bill or invoice they turn it into their insurance plan the insurance plan may say well it's nice that you're charging 150 but we think that's too much basically we we think we're only going to allow a hundred dollars uh and i'm just making up these numbers we think that that's really the usual customary and reasonable rate for that service provided by that kind of provider now we're going to talk a little bit more in a future questions here about how they come up with those numbers because sometimes we're kind of surprised but the bottom line is these are both that that out of network provider allowed amount is something that they've determined and each plan determines it differently um what is an acceptable amount that they're willing to pay for that service and again back to network provider that's clearer you have already contracted with that you've already agreed to that allowed amount so it's the amount basically the land amount is all the plan is going to consider for that the amount that they consider reasonable for that service let me ask you barbara yeah there's at least a couple of circumstances where i've seen people accidentally bill lower than their contracted rate and it seems like the insurance company sometimes is more than happy to pay what they are asking for even though it's less than their rate does that ever happen or sure um there's certain situations i don't want to like kind of encourage this too much but like um where if you accidentally or on purpose sometimes you might give a sliding scale fee to someone in network it's not usually the case but anyway if you accidentally lower it they absolutely are going to go with whatever your build amount is going to be they're not going to pay more than you they're going to say hey knock knock knock you should charge more than this but definitely as an out-of-network provider you you have every right to slide your fee all over the place down to 10 or zero or whatever you just need to reflect that amount on your super bill or invoice when you turn it into the insurance plan and then they will see whether that's within their usual customary and reasonable rate and again that's called a ucr or usual customary and reasonable rate or a loud amount those are all the same terms for what we think is reasonable for that bill so this is their way of keeping us from just increasing our rates and saying oh they're paying 200 why don't i charge 250 why don't i charge 300 um this is their way of saying this our cat we're capping this so the next question we have here from kdr what do insurance plans base their reimbursement rates on good question all right so just some key factors we'll go through them quickly some of these are in the mental health parity law that allow insurance plans to use some um what do we call them factors to uh to adjust rates between different um services and different therapists so one is your location that's a huge one uh therapist in beverly hills might be be paying a paid a lot more than a therapist in bakersfield or you know in the middle of the sticks so they're going to look at your zip code they're going to look at what they call the geographic market so what area are you in and what are what are the rates in your area another one is just the demand for services in your area if you're if there's a lot of therapists there's a lot of clients they're going to look at that and the need for services in your area and they're going to look at this one isn't exactly on there but sometimes they can even look at their need for providers in your area you know if they really need you in the area they don't have enough therapists they might pay more so that's oh yeah that is the next one provider supply in the area um so if you're located in a very um densely populated area which has a ton of therapists and they have enough therapists they may not have the need to pay you more than someone else your practice size may be a factor they may be willing to pay groups more because the group may be able to give multi-practice multidisciplinary options to the to the insurance plan or maybe the provider group has negotiated because they have so many things to offer and because they have one billing site and kind of certain things are easier instead of the insurance plan having to write 15 checks it's all done through one group it simplifies things they may be able to pay more get more provider license is a huge one excuse me provider license is a huge one um if you if a psychologist uh and and uh mft were both applying to the same insurance plan uh probably the psychologist is going to be paid more reimbursed more it could just be based on experience and training service type the cpt code that you're providing is definitely a big factor they're going to pay different amounts perhaps for a diagnostic interview versus a just a psychotherapy session now how is the ucr that we talked about the usual customary reasonable fee sometimes it's an average of what other similar providers in your area or even nationwide charge for that service so kind it often is like 75 or 80 percent of what the average is for what similar providers in your area charge so they have their own little formulas is basically what i'm saying they're allowed to have their own little formulas and it varies from insurance plan to insurance plan also private health plans may use some percentage of the medicare rate so even though you're not a medicare provider they may be basing it on on the medicare rate so it's all these weird things that are out there and sometimes it's a lot of who knows i i don't even know sometimes why some insurance plans seem to have a very high ucr and some have a much lower one so the next question my colleague who has the same license as i do and works nearby gets paid more by the plan than i do why is this from sean f right i get this question all the time and uh the only things i can guess these are these are like gases one is a successful raise request maybe your colleague asked for a raise somewhere along the line and got it um and we're going to be talking about raises a lot more later but that is definitely some possibility it's possible that your colleague has a different license i think this question though it was mentioned that they didn't have a different license different location even though it may be that this person's located nearby which the question said you know it could be a different zip code it could be a different um just it may seem close to you but to the insurance plan who's located you know in another state they may have you just listed as a different zip code and that's good enough to give a different dollar amount another one is and this seems weird but joined later i know some of the plans i've been with i've been with 28 years and i i see new people come along and i know some of them are getting paid more than than i am and i i have a feeling again we're going to talk about this later that some of them you know the insurance plans just never really gave passed along um increases to be since i'm such an old provider basically and yet when these people joined they were put on it at a higher rate so i kind of think that sometimes if you never ask for a raise you can't just sit back and hope that they come along and give you one i have a feeling that rates go up over time and sometimes veteran providers are not offered those um i'd like to think that's not true but i suspect that let's say put that away and the biggest uh answer i have for this is it it seems to me often a complete mystery why um providers that i talk to and we're really not supposed to talk about our rates because we all have independent contracts and it's that's a whole other topic but it's kind of a complete mystery as to why if you gathered a room of 25 providers with the same insurance plan that are on the same insurance plan you know you might have people have having 25 different rates um i'm not sure why it's not more uh that everyone's getting the same rate so i think that's part of the weird mystery magic of insurance plans is there's a lot that's behind the curtains that we really don't really know why next question why is it difficult to obtain reimbursement rates before joining a plan from marissa g yeah this one's like you should be able to people are always coming to me and saying i really want to join an insurance plan but how do i know which ones are can i just call them up and ask them like what they pay so i can know whether it's worth my time to go through the applying and filling out paperwork and and trying to join them and the the interesting thing you'll probably find is if you were to call insurance plans and say hey i'm an mft or i'm an lcsw what do you reimburse people they they often will not tell you ahead of time you have to you know because then they would have to look up your zip code they would have to look at your whole situation or whatever and they they pretty much in general most plans will not tell you ahead of time you have to make a formal application if they're interested in you they will take the time to send you a contract and then the contract will say sometimes not very clearly sometimes then you have to like call up and say what does this mean 75 of the medicare rate what is the medicare rate you know sometimes it very clearly lays out for each cpt code what you can imagine that you're going to be paid or what you will be paid but sometimes you have to go through the whole process of applying to find this out i don't know all the reasons maybe insurance plans just don't want to bother going and at you know looking up for each person who calls them you know what the zip codes are what the formula is for that their area their license and the cpt codes maybe they don't want to bother do all health plans pay the same rate for the same service from arita jay yeah i i was going to say i wish i'm not sure i wish it depends what the health plan is um no definitely not so that would make some sense but no each health plan again is an independent company and they have the right or the ability to um for each cpt code to say what they think they're going to pay and it may vary depending on as we said depending on your location and depending on lots of things but they definitely if you compare each health plan you're going to find every health plan pays something different for the same service what about telehealth is telehealth reimbursed at the same rate as in person will coverage rates be going down in the future from ellen so i put it under ellen's name but we actually had a lot of questions about telehealth and i was kind of like yeah i know that's what's on everyone's mind but it's a little bit off what our topic is today but i stuck them all in here today saying um you know i'll touch on telehealth today but for the most part that's a whole other topic and i think our next ask a biller is a telehealth update avery maybe can remind me if it isn't but anyway um the general issue about reimbursement is that telehealth is not always reimbursed at the same rate as in person it depends what state you're in it depends um what kind of so so if your state has telehealth parity laws that protect parity means they have to pay at the same coverage parity excuse me there's coverage parity and payment parity if they have payment parity laws which says that they have to pay in telehealth at the same rate as in person then you're probably good unfortunately not all states and i don't even think half the states have payment parity laws now that doesn't mean that they don't pay at the same rate but it just means they don't have to pay at the same rate so it is possible that you could be doing telehealth and not be reimbursed at the same rate for in person i haven't heard a lot of people tell me that that's happening to them but i have heard some people say that a few people around the country are saying that to me that they are seeing their telehealth reimbursed at a lower rate i'm hoping that that is something that we're going to see not happening again that we're going to see legislation in each state don't look for fed i mean there's there's going to be federal legislation but really this has got to happen on a state-by-state uh basis because states really rule what happens in their state ing to telehealth and reimbursement and so definitely all i can tell you is go to your state and go to professional associations try to try to um be very ad advocate for this at the state level but and in terms of whether will coverage rates be going down in the future i i hope not i can't see around the corner i don't have my crystal ball but i i don't think so i would like to say that that um we're gonna see more telehealth we're going to hopefully um see more legislation paths to support that and i don't don't see any reason why coverage rates should be going down in the future but who knows so the next topic here is raises you want to say anything about that really quickly barbara well we'll just this is this is the probably the number one question i get as um well no well let's just jump in first question will health plans automatically increase my reimbursement rates over time to reflect my length of time on the panel or cost of living increases from megan e well megan wouldn't that be nice um like i said i've been on some of my panels 28 30 years and you know some of those plans i only got you know one raise or cost of living increase or something you know it's just it's just no i would say you cannot re rely on the insurance plans i'd say lately i got i've gotten a few from a couple plans but you can't rely on that for all the plans that you work with that cost of living increases um or that they'll come along so um i guess i want to say this other thing and this is a little to the side but sometimes i have people calling me therapists for consultations and they're really complaining about the cons about the rates and they're like this late the rates are so low the rates are so low the rates are so low and i totally agree with you but at the same time what i want to say to them is you agreed to this rate when you signed up um so you know always before you sign on with the panel please look at the rates closely don't just sign anything which we sometimes do look carefully do not sign any contract until you look at that rate and you say to yourself can i live with that rate um there we don't want to get resentful over something that we agreed to in the first place right and then obviously if in time you're like yeah i can no longer um uh agree to that without being resentful then then we need to look at resigning which is the next section so but yes are asking for a raise so no i the answer to this megan is that no like sometimes health plans will increase your reimbursement rates over time but you can always count on that next question can you really get a raise from a health plan massage w yeah so this is something people a lot of people don't realize um i was stuck in this one therapist survey it's a little old but it's still that low reimbursement rates was the biggest therapist complaint about insurance panels by far and this does not surprise anyone listening here i mean that's probably all of our biggest complaints yet 61 had never asked for a rate increase and when you know when i go around and i ask people why haven't you either people didn't know that that was even a possibility how oh i can ask for a raise and i called the rate increase because we're not really technically raised raised to somebody if you're a salaried individual um but rate increase but 61 of us had never asked for a rate increase what we don't either know it was a possibility or the ones who know it's a possibility said well they're not going to give me one now like what would our client what would we say to our clients if we if they said well i'm not going to ask for something because i don't think i'm going to get it we would say well you got to try babe you know um so you're definitely not gonna get it if you don't ask for it um and you do have a chance if you ask so here's a very interesting survey excuse me finding 40 of those who had requested a rate increase had been successful now 40 is a pretty good number um and in my past i have asked for raises and i would say my number is probably not that high of 40 percent of my raise but i definitely would be one of those people who said yes i have requested raises and i have been successful probably i don't know five times in the times that i've asked and i haven't asked as many times as i should but bottom line is yes this can happen sasha and we all should try it instead of grumbling you know definitely try it and at least we can find out whether we would have had a chance can i negotiate a higher reimbursement rate before joining a plan for nvidia g yeah so before joining a plan it's a little tough it can be done i've done it before myself um if you're in a hurry to get on a plan this will usually delay you getting on a plan and sometimes getting joining a plan can take uh shortest time probably three months more likely six months sometimes nine months so if you're like in a hurry and they come back to you and they say okay we're willing to have you come on our plan here's the rates and you now want to negotiate it it can now delay it longer as you go back and forth or you say hey i want to join but i don't like those rates i want to you know negotiate something higher i would do this if you are bilingual if you have something really hot that you think they're going to pay more for and language is probably the number one thing we're going to talk about that but you can often get that i did um i negotiated a raise before joining a plan that was an eap employee assistance program because i had critical incident stress debriefing training and i had provided mandatory uh wellness workshops or i guess employee training for like substance abuse and sexual harassment trainings at um employers so if there's something that you think you might be able to get paid more for right in the door that they might you might be able to get up front but again just know that that might delay you getting on the panel a little bit next question what should i say to the health plan when asking for a raise from min okay lots i put together two whole slides on this because it's like such a big topic all right so like i said big the biggest you you're going to highlight in a letter i would put together like a letter what makes you stand out and we'll talk about a little bit more what the steps are but what are the things you're going to highlight to them how are you different this is a question i would ask yourself how are you different than all the therapists in your office or that you know what makes you more valuable to the insurance plan that they might be willing to pay more for you so one is bilingual or multilingual if you speak other languages sign language anything that you can now address some populations that they may be you know just english speakers are not able to um one thing i didn't put on here is if you have multiple um office locations that can that used to be more important now with telehealth not so much but still that i think that's something i would highlight because many health plans still want to see uh have providers who who do have office locations for those clients who do want to be seen in person what are your specialties and please don't just highlight anxiety depression couples they kind of expect us all to do anxiety and depression so go beyond that what are your specialties that maybe they would really need on their panel a couple suggestions i have in here like addictions if you have that kind of training or experience put that on here eating disorders if you've ever worked with that population your experience in training in evidence-based treatments they're very big now on evidence-based treatments so any training or experience you have in brief symptom-focused treatment like cbt dbt emdr they may pay more for emdr aba for those of you who work with kids autistic kids mindfulness-based stress reduction so anything like that that's kind of training that you've had specialized training as i said in critical incidents stress debriefing wellness workshops that you can go into an employer and teach how to survive the holidays or you can teach um you know stress reduction or you can teach anger management or those kind of lunchtime things employee assistance program is really like that if you use objective tests to measure symptoms and track progress they love this excuse me um this is something that we you know if you're going to be around a while in this field you're probably going to have not going to have to gravitate to but it is something that more and more insurance plans are probably going to be gravitating to wanting us to do um and so being able to show that we are um benefiting clients and we are showing that we're able to measure uh progress symptoms having those kind of objective tests like the gad7 phq9 the burns anxiety inventory there's all kinds of little tests that you can give and as a side note you can sometimes charge insurance a little extra for giving those tests or even just having the clients fill them out online so if you want more information about that i'm going to give you at the at the end of this or in the middle of this i'm going to give you a a web address for you to ask any follow-up questions or of me i'm going to answer all of them or to basically get more information about some of this stuff okay so special populations do you work with lgbt um especially if you have kind of a trans focus or you're very comfortable or you have a lot of training working with trans folks veterans children and teens that's usually many health plans don't have enough providers for children or teens couple other things highlight diversity diversity is a big buzzword right now not only your familiarity working with a diverse population immigration issues culturalization issues but highlight yours if you are a therapist of color if you are um you know what however you want to identify yourself if you're a non-caucasian and you're able to say that basically you may help them meet a network inadequacy of you want to fill their diversity of providers right so highlight that use it just tell them if you're a therapist of color tell them you're a nation therapist tell them you're right whatever if you have unusual availability like weekends that's nice to highlight if you have old experience i'd call it uh even if you don't want these referrals what i'm talking about there maybe when i was an intern associate i served in a chemical dependency treatment hospital and do i want addicts in my practice now maybe not but definitely just tell them in your that you have experience working with chemically dependent you know people and that's really informs your practice now in terms of your ability to assess for that or whatever or you worked with in a severe mental health clinic or with severe diagnosis or dual diagnosis don't be afraid that if you tell them these things you're going to now have a glut of referrals from about that you're just saying look i've got all this terrific experience other things if it's impressive how long have you been with the plan how long since raised how many members do you see are you a high volume provider do you have a lot of their clients that's kind of and i mean notice how often i use the word members that's how they refer to them so i usually don't use the word clients when i'm talking to a health plan i talk about members all right and a couple of other just quick tips don't assume you have none of what i've just outlined that you can't get a raise go ahead put your best foot forward and ask for one i would say i am almost half the time wrong about if i guess who's going to get a raise it seems like such a dice roll to me half the people that i think this one is going to surely get raised because of her experience she doesn't get it and then i think that one is definitely not going to get a raise because they've really kind of a garden variety therapist they really don't have any specialties and they get one so don't make any assumptions also don't whine focus on what makes you worth more money don't be saying oh my kid needs you know orthodontia appointment and i have these bills to pay and you know don't kind of yell at them for not increasing your raise you might mention it but um don't talk about student loans you have out you doing focus on i'm worth more money and here's another weird tip that could be used in certain situations but you can go on the plans provider directory which is public and i've done this a lot and try to prove that you have something that the other the provider needs that you are going to meet help them meet a network in adequacy for example one of my clients that i was coaching somebody to get a raise and she um was she spoke i can't remember what let's just say she spoke spanish and so we went on the provider directory and we typed in spanish-speaking providers you know in her area and she was able to see that this plan only had whatever three providers in her zip code that spoke spanish so now she can use that in her argument she can say hey plant you only have three spanish speaking providers in our zip code you know that's not good that's not enough so if you can give some hard facts that can be helpful and the provider directories are online if you need help finding some of them i'm able to help that with that all right what is the best way to request a raise after working with an insurance company for over three years from cheryl l great question so here's the steps basically for anyone no matter if it's been three years or 20 years you're going to write a raised request letter and that's something i can help you customize but i'm also going to give you a sample if you stay stay tuned i'm going to give you a sample that you can download instantly when this is over um then call the health plan you're going to want to probably talk to provider relations and just say look i want to know where to send my my letter to ask for a rate request letter i mean yeah but i want you to have your letter already written because be prepared to give your pitch on the phone because it happened to me one time i called them and asked them you know where do i send my letter and she said well i can just talk to you about it right now and i was like like i'm so glad i've already written this and i have my little bullet points and i have my little pitch ready so that's why i put number two as number two instead of number one um so i was able to in that phone call talk to her on the phone and that was actually one of the times i was able to get a um um raise interestingly though i'll just share this on the phone she said well how much of a raise do you want and i was like unprepared for that question a little bit i had written the most of the letter but i hadn't quite finished it to that and so i asked for a number and she said okay and i would thought to myself oh i should have asked for more um so again be prepared which we'll talk a little bit more later but for how much you exactly want for each cpt code that you provide and remember cpt codes in case people have forgotten those are those five digit codes that say what kind of service you provide you want to tell them every cpt code that's like whether it's a individual session 60 minutes or it's a couple session 50 minutes or it's a diagnostic intake session it's those five digit codes 37 908 47. um okay so where do we say no okay so then you've got your letter they tell you where to where to send it but then kind of ignore them um and you definitely want to send it wherever they said to but then also email it if you have an email address fax it if you have a fax address mail it just like try to send it ever to everyone at the plan that you can if you're in their eap program make sure you send a separate one to the eap program um because that's kind of a separate that you sometimes are separate so just basically send it to everyone and see who responds allow four to six weeks for response and then obviously follow up if you get no response insurance plans are notorious for not responding sometimes to things they really don't want to deal with and raise requests sometimes are things they don't want to deal with my experience is sometimes you'll get a little postcard in the mail saying no really quickly from some and they'll tell you we have such a great website um we don't see why we need to pay you more or we have done these great things for you since you joined and we don't see what you know it's like a it's the same one that they said to everybody it's not like customized for you in any way and i've one plan i asked many years i got the same one ten years separated like they still were cutting the same rejection letter um and it said the same things on it so that was kind of funny that's when i quit them after that um so follow up if you get no response make sure they got your letter and then you know i would say try again in six months if you get a rejection but sometimes they will actually say don't try again for one year or don't try again for two years they may actually tell you we won't even consider your request again i don't know if i'd bother listening to that can't hurt to try again in six months right i i don't think they're keeping huge track but i'd probably try again in six months depending on how much you really want to get that raise should i ask for specific dollar amounts for each cpt code i use from jill l yes definitely jill um don't yeah because if if we just write a letter to them and say i wanna raise you know maybe they come back and they're like okay i'll give you five bucks you know and you'll be like what that's not going i would have had in mind um it's better to um write down every cpt code that you use or could possibly use even ones you don't really use now but maybe you would use in the future like maybe you're not doing couples work very often but once in a while you do you might as well you're dipping into that well go ahead and ask for more money so that when you do start doing couples or you do end up doing some couples work you're already gonna get more for that so go ahead and ask and what i people are like what do you think how much should i ask for don't think you should be asking for like your usual customary your usual fee like if your usual fee is 150 and right now you're getting paid 60 i don't think it's reasonable to go and say hey i want 150. you know the whole idea is that you're willing to to accept a discount to be on an insurance plan and in resp in return they're sending you a lot of their members and you know so it's supposed to be kind of a deal i encourage people you know it's up to you but i think a 20 increase is probably reasonable they might go for it at them um but if you want to try more that's fine how often can i request a raise is there a best time to ask for raises from jamal n and charles s yeah again some insurance plans will say that they will only consider you after you've been with the plan for a period of time maybe a year or two um or if if you haven't asked for a raise in a year or two those are some sometimes they'll say that sometimes not so if if you haven't been given any directive again i would ask for one whenever you want to ask for one and then if they re refuse you then you know wait a period of time six months or a year i guess one way i think about it is that i think a raise request often lands on somebody's desk over there at the health plan and then maybe six months later it may land on somebody else's desk who has a different inclination and you might get it i just so see ray's request as a dice roll and you know you just roll your dices as dice as dice as many times as you can and you never know what the outcome's going to be so i don't never think of insurance plan as just wildly organized uh full of rules place i think sometimes we just need to keep knocking at the door and maybe somebody will let us in it may not be the same person who last time told us to go away and not come back for a year it maybe you knock at the door after six months and they're like oh come on in what do you want um so that's my my the way i look at it so barbara you want to just go ahead and just talk a little bit about this you already know yeah i thought long and hard i don't usually give this special freebie out but i wanted to do it for you guys uh this is very special for me but this is a sample raise request letter um usually i only give this with people who are consulting with me about writing a raise request letter but i thought all right for this one i'm just going to give it out to you guys it's a sample letter of you writing to a health plan and asking them for an increase a rate request and so you can see kind of how i would lay it out and kind of how to it's it's really chock full of some possibilities you can even use it as a template you can borrow some of the sentences for you that apply to you or kind of rewrite them so when you go to this i want you to see this the thing that's highlighted in yellow there the insurance maze.com write this down the insurance maze.com backslash rates you could go there now but i don't want you to visual i want you to still pay attention the insurancemaze.com backslash rates you can not only download this letter you can ask any follow-up questions you have from today so if you're not interested in the letter or if you are i've also put a blank area there that you can just ask any of your personal follow-up questions specific to you or that didn't get answered today and i will answer all of them or if you just want to join my mailing list and be notified of future webinars or other things that are going on or changes that are happening in the insurance world that affect you and your clients definitely get on there so the insurance maze don't forget the insurancemaze.com backslash rates i'm going to show you this again but take a minute right now to write that down and you can get your sample raise request letter give everybody just a second here thanks all right and if you guys need help uh putting together yours even after looking at this when you're like yeah i still want help you know writing my own then that's something we can schedule a consultation and i can help you write your raise request letter all right now yeah resignations let's see all right what should i think about before i resign andrea s okay so obviously the first question have you tried asking for a raise if money is the issue a lot of people jump to resignation because they're really pissed off with the plan or they're having trouble or you know getting reimbursed or they're having trouble reaching the plan or something and but a lot of the times it's just like i'm don't want to just tolerate the low reimbursement rate so be sure you've tried it that's the main issue ask for a raise first then when you leave at least you know you've tried right ask yourself a couple questions how many clients come to you because you're contracted with that health plan is that a major referral source for you and kind of look through your list of current clients and past clients and just try to you know what would that be like basically if that referral source goes away which is number three are you willing to work a little harder at marketing your practice if this referral source goes away so some of us who work with insurance we get a little comfy because you know sometimes a lot of our clients do come in the door because we are on their insurance plan directory or they see on our websites that we take their insurance and we i think we have to recognize that we may need to to fill empty slots in our practice ourselves in a whole different way so we might have to work a little harder at marketing and one thing that i would tell myself is if i'm going to quit then any free hours i have like free client hours i'm going to use that hour to market i'm going to have to think about how am i going to get butts in seats as i say and how am i going to get people who already have insurance to pay for my services even though they don't have insurance excuse me even though they i don't accept their insurance or i have to get people who don't have insurance to come to me so and then the fourth one here how many of your current clients with that health plan can afford to see you if they have to pay privately so i'd kind of go through and make calculations are you willing to lose some clients and you definitely might lose some clients i know when i have quit health plans in the past i have lost some clients um and i had mixed feelings about that in terms of some of the people who really weren't willing to continue even though i slid my scale but anyway just those are some of the things to think about yeah what are the steps determined provider contract with an insurance company from sarah f all right so this is a long slide here call the health plan provider relations department verify the amount of notice that you need that's needed to resign many health plans when you signed up with them they told you that you needed 60 days notice 90 days notice a couple are 120 days notice so what that's talking about it could be two three four months notice you need to give them so plan ahead here and definitely ask the health plan you can check your contract but might as well when you're calling them ask them how much notice do i need to give ask where to send your letter and or your email to resign and then while you're on the phone with them ask them to list you as unavailable for new referrals and write that resignation letter and here's your chance to tell them why you're leaving give them a parting shot here and tell them if it's about rates then you need to tell them they need to be hearing why great providers are leaving them and here's our chance for feedback and give them your proposed effective date i'll say more about that in a minute so you count if it's three months count from when you're writing a letter and kind of say you know my my uh determination is that i will be continuing to see clients with your plan for the next three months whatever then email and fax and mail do that same thing we talked about before every contact information you have to everyone at that plan and i don't mean your clients i mean the plan itself um and send a separate letter to eaps resigning just like tell them everybody that you can i'm i'm i'm gone then allow four weeks for a response follow up if you get no response and if you don't hear back from them within that four weeks oh contact i'm sorry that's the same thing as number four you are not off the plan until you get written confirmation which states your end date um this is so important i've seen many providers who didn't get their written confirmation they thought they just counted three months or whatever they thought they must be off turned out the plan never got there or never in um put their resignation into the database for whatever reason it was a big mess so definitely get some written confirmation in your hot little hands before you um and they may give you a different end date i've had that happen probably three times is that the date i thought they came back and said you know we see that you're now we got your resignation your end date is blunk blunk and it's a different date um sometimes they're going to be three months from the date they received it it might be three months from the end of the month that they received it it might be three months from when they put it in their computer so that's the important part all right next okay if i leave a client's health plan can i charge that client my regular private pay fee or do i need to continue to offer my insurance discounted rate from jeremy n yeah usually there is nothing unless there's something specified in your contract usually you can offer your regular private pay clea fee this client has now become a private pay client i've been avoiding resigning because of one client that i know can't afford to see me privately are there any options from pena d yeah sometimes you can um well i was going to say something i was saying can you do that yeah okay so uh sometimes you can work out a special case agreement it's called with that insurance plan to continue to see one of their clients um and i did this with an insurance united behavioral health when i left them um one of their clients really couldn't afford to pay to see me privately so it turned out that i worked out a agreement with with ubh and i continued to see her i continued to act as a um network provider for just her and um everything was pretty much the same except i was able to actually negotiate a higher rate strangely enough so if you do a single case agreement and they will sometimes do that because you are the person who knows that case intimately and they don't really want this person to start over with someone else and you know you'd have to argue that you are the one that can help them reach their treatment plan goals fastest um and at the end basically you're going to cost least money for them to continue with you but it's something you have to consider and if you're ever thinking about a single case agreement contact me i'll tell you the pros and cons but it is something that's a possibility do you have to resign how do you get off panels if you decide to not resign with one or more of them from alexandra w so just you must keep honoring your contract with a plan until resign and your resignations effective so if you're new get new health plan referrals you can't say well i'm not taking any new insurance clients but i'll see you if you pay privately so whenever you're on a health plan you can't say well i'm going to do a bait and switch basically you um you're coming to me i'm not taking insurance clients but i'll see you if you pay privately that can get you in big trouble but if you don't want to take on new clients you can either resign from the panel or tell them a potential new client you just don't have any openings even if you do so during that time when you're in that resignation period you're just going to have to chill about taking new people and just be really honest about anyone who comes to you from that insurance plan tell them you're in the process of getting off the panel once i submit my resignation letter what do i need to do then okay we'll try to go through this quickly tell your clients sometimes the insurance plan will reach out to any client that you have currently with that plan and say hey guess what your your person is leaving our plan so you want to be the first one to tell them discuss their ongoing treatment options they can either continue to pay to see you and pay privately that seems obvious and remind them if they have a ppo or a pos plan those are insurance plans they may be able to get some kind of out of network reimbursement so you may have to educate them about that if you don't really understand that talk to me and i'll help you understand more about that or another option they can just end this their chapter of therapy or you can refer them perhaps to someone on their network or to some other self-help group in the area or whatever if it's a they don't want to continue or can't afford to continue document in your chart this is so important your discussions that you let them know and their what their response was every time you talk to them about ending and why and what discussions are document because ending is a is one of those situations that sometimes clients have complaints about they can they can charge you with abandonment they can charge that you left them you know without any referrals so you want to make sure that you document in your chart any referrals that were given what you talked to them about the options i would even follow up with it number four there send an email or letter to the client following up with the conversation officially notifying them of your end date and their options keep a copy of this in their chart and if the client's going to continue to see you privately have them sign a private pay agreement basically it states i you understand now i'm no longer going to be billing insurance you're agreeing to pay privately here's how much you're going to be paying you agree to all this you understand all this and i have a form like that available in my private practice excuse me practice forms packet at on my store page of my website all right well barbara it looks like that was last question here in the slide um again there that's where to go the insurance maze.com write that down if you didn't rates back such rates and that's where you get your sample raise request letter you ask any follow-up questions i will respond join my mailing list any other there's also lots of other cool therapist resources i'm going to put on that page so you can check it out all right so we do have a couple questions that might be able to get to um i'll just throw you can i compare a higher paying insurance to a lower paying to get equal rates that's a great question i have struggled with whether i should or shouldn't um i have i have said that your rate is no longer commensurate or competitive or whatever the word is i'm thinking of with the other plans in our area including you know and i give two that are paying me higher than this so uh yeah um i've done it um so i don't know it's a hard one to know whether they will be offended by it but i think it's some i think it's important to call them out and say you know if ucr's our allowed amounts are based on um what's what's the going rate they're no longer competitive the going rate is what other insurance plans are paying for that same rate i think it's important to tell them okay well let me throw one more at you let's see how can those who are still provisionally licensed and gaining supervision prepare to get onto insurance panels asap once independently licensed that's a great question one of the problems is some of the big insurance plans will want you to be licensed two years or three years before you can even join a panel um we did a whole presentation with eska biller on joining plans so you may want to watch that which is i think that's stored on the archive page there that we talked about earlier don't hold off applying but some of the smaller plans might allow you as soon as you're licensed to go ahead and and join try to get on those but apply for everyone and see what they do but you just have to as soon as you're ready to go just have a list of insurance plans that you want to apply to start making phone calls um and try to get on them but again just be prepared that many of the bigger plans maybe the blue cross blue shields maybe some of the big ones are going to say you need to wait so you've been licensed two or three years unless in your area they're really needing therapists which they may not be so go ahead and again don't let anything keep you down just go ahead and apply anyway and definitely watch that video that we did for askabiller about joining plans that i think will be helpful all right cool we are out of time here so everybody okay we're joining and barbara thanks so much for going in my pleasure thanks everyone for coming