Counseling Today, Private Practice in Counseling

By any other name, it’s still fraud

Robert J. Walsh and Norman C. Dasenbrook October 1, 2007

Q: I have just joined an established private practice. The majority of clients in this practice want to use their third-party (insurance) benefits. I am applying to get on insurance and managed care panels. In the meantime, I have two new clients who have insurance that won’t cover me. The practice has offered to bill under another therapist’s name until I can get paneled. What do you think?

A: Fraud is what we think. You cannot treat a client and submit a bill to a managed care or insurance company using another therapist’s name and National Provider Identifier number. Only the therapist who actually performs the counseling and has been accepted as a provider can bill for services for that client. The practice could have a corporation contract with the managed care company, but each therapist in that practice has to be approved by the managed care or insurance company individually.

Q: Could you give me some direction on this? On more than one occasion, I have been contacted by a “potential client” who is covered by a major insurance company, only to discover that the person’s “mental health and addictions” coverage is by a managed care company for which I am not a provider. Why am I listed as an option for them when they are seeking a counselor if their particular plan does not allow me to provide services to them?

A: The problem is that some insurance companies have what they call a “carve out,” or a separate managed care company that provides mental health coverage for some of their members. For example, some Blue Cross plans have Magellan administer the mental health portion of their coverage. You may be a Blue Cross provider, but not be on Magellan’s list of approved providers.

A way to get around this is to have the client send a letter (for an example of these letters, see the “Private Practice Pointers” section of ACA’s website at www.counseling.org; the link is on the “Counselors” page). A call by the client to the human resources benefits manager has also worked to get counselors on a panel. Companies’ benefits managers are good levers because they want employees to be satisfied, and the benefits manager’s job is to service them.

Q: I attended your seminar on starting a private practice about five years ago. Since then, I’ve gained a lot of knowledge and experience working in a large group private practice — for somebody else. Now I’m really ready (seriously) to get out there on my own. Any pointers on locating office space? I have to be seven miles from the offices I work in now (for my current employer). Also, I’m interested in supervising new grads that need (licensure) supervision. Any ideas on that one?

A: Try calling established mental health providers in the area that you’re interested in to sublet space. Another idea is to take a chance and contact an M.D. who may have open office space. If you choose the first route, try to contact a counselor who is not in your niche so you can avoid competing over clients. If you choose the second route, try to choose a doctor who is in your niche so you can share clients. The worst thing that can happen by attempting either of these approaches is that you’ll get told “no.” But maybe you’ll get a “yes” instead. Take the risk — isn’t that what we encourage our clients to do?

As far as providing supervision, it’s a good idea as long as you are licensed and qualified. Many newly licensed graduates need supervised hours, and it’s an added income stream for you. Both you and the students will benefit.

We hope to see you in Hawaii at the ACA Conference & Expo, where we’ll be presenting our preconference workshop “Starting, Maintaining and Expanding a Successful Private Practice” on March 27, 2008. Onsite private practice consultation will be available. Come visit us in the exhibitor center and preview our book, The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counseling-privatepractice.com).

ACA members can e-mail their questions to Robert J. Walsh and Norman C. Dasenbrook at walshgasp@aol.com and access a series of “Private Practice Pointers” on the ACA website at www.counseling.org.