Things to know when you bill insurance companies

There are a few things to keep in mind when you are billing any insurance companies for reimbursement.

  • You must bill all insurance companies the same.  That is, you should have “standard fees” that you use when you are billing insurance.  Preferential billing (billing one insurance company more than others) is frowned upon in the industry)
  • You should have set fees for the different CPT (billing) codes.  In our business, 90801 is the initial assessment, 90806 is the 50 minute follow up counseling session, and 90847 is for family counseling.  Those are the biggies…
  • Make sure your fees are high enough — you don’t want to leave any money on the table.  If you are billing $85 for 90806, your reimbursement is going to be based on that fee.  If the insurance company you billed will pay up to $100 for 90806, you will have left $15 on the table
  • Remember that all insurance companies are not created equal.  Insurance companies will reimburse based on what they consider to be “usual and customary” in your region.  So, if you bill $125 for 90806, you may get the whole thing from some, 80.18, from others, and $60 from others (for example).  You will be paid based on their fee schedules
  • When you are billing as an out-of-network provider, you may make more money than if you were on panel.  When you become paneled provider for an insurance company, you agree to accept their fee schedule and you CANNOT bill the balance to the client.  When you are out-of-network, you can bill your full fee and sometimes their reimbursements are based on a percentage (i.e. they may reimburse 80%, leaving the balance of 20% to the client).  When that happens, you will make more out-of-network than in-network.

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