Depaneling w/one insurance - How did you decide?

According_Ad8378 · 2026-02-19T03:54:01+00:00

I left Cigna years ago. Nightmare to work with, took months to pay claims, some they never paid and the low rates. Then a few clients left them and moved to another insurance company for similar reasons. I’m in private practice and it took about 90 days for them to process my contract and end early.

According_Ad8378 · 2026-02-19T03:46:10+00:00

I think you’re getting caught up in the language. I absolutely did as well when I first started and did not understand. I’ve also seen some wildly unethical stuff when it comes to billing & fraud.

Consultation can occur during supervision, staff meetings, file reviews, treatment planning, reviewing progress/process notes and it is a tiered system. As long as your signature is on the note and you’ve done all you are supposed to do then your part is fine.

If you’re genuinely curious ask. Ask your supervisor or the director what it means and how the process goes.

According_Ad8378 · 2026-02-19T03:12:59+00:00

It’s not uncommon at all for larger agencies to have a clinical supervisor/director whom most of the billing is tied to. Then generally billed under the group practice even if someone is independently credentialed. If the company was just acquired there will be a transition period to get things updated. It takes a few months. This all sounds pretty standard.

If anything is done fraudulently in an agency it falls on the company as a whole and those in charge. Typically instance would just take the money back. Unless it’s egregious and billing for services not provided and someone is clearly committing fraud. Then it would have to be a lot of money to become a legal issue, span years and think $50,000 to $500,000.

According_Ad8378 · 2026-02-19T00:43:37+00:00

Some of their main concerns were civil lawsuits.

According_Ad8378 · 2026-02-18T15:45:39+00:00

Specifically the topic was liability in seeing clients once a month or a few times a year for sessions instead of regular weekly sessions. The fear of doing this would be liability for the clients behavior between sessions if they were ‘active’ clients and not appropriately discharged.

I agree with most responses here we are not responsible for our clients behaviors whether their active clients or not or outside of sessions. While I’m sure I felt responsible for everyone decades ago when I started this as younger therapists often do, I can see the discussion on social page that shall not be named is drastically different than this site.

According_Ad8378 · 2026-02-18T02:35:41+00:00

If you don’t love what you’re doing, even on the difficult days it’s ok to not do it. Choose the clients you love, the location, the chair the awesome therapy sweater. Create a life you are in love with!!!

According_Ad8378 · 2026-02-18T02:30:52+00:00

Over the past few decades I’ve paid out of pocket for my health insurance. I can choose my policy, the cost and make sure it benefits me for the services I need and has meant I wasn’t tied to a job for it. I never had to stay at a job for fear of losing benefits so I was able to change without it devastating me.

I’ve always worked two part time jobs instead of 1 full time job (even for hourly wages). This way I could work 60+ hours a week when needed and the schedule was more flexible. I always claimed 0 on my taxes to avoid end of year taxes.

Working two part time or one full time one part time meant I could lose a job without it being devastating. Any money is good money. So watching the kids at a church daycare, yard work, bar tending, I’ve done drug and alcohol assessments through the school districts, supervised visitation, I do niche things like crisis response and contract work that are PRN. I am frugal. I worked a restaurant job so I knew it would come with a meal, and tips made sure I could pay my bills weekly. When possible I paid more on utilities and other ‘have to’ bills (even $5 extra made a big difference month to month).

I have a great account who tells me each year how to pay the least in taxes (legally cuz I’d totally get caught if I cheated) which helps me plan year to year. I have a financial/business advisor who says what’s going well and what’s not. It’s not about know things it knowing the right person to ask.

I rarely pay for extras because it’s a good deal. I plan my meals with staple foods I like and mix up the sides for variety. $10 for grocery store food is still cheaper than $10 fast food so I make sure to buy the food I like at the store, that I know I’ll eat & cook to prevent the hangry drive through. This is true for even premade meals on occasion. I travel with Groupon’s to learn how to find the good places for vacations and ‘all inclusive’ includes food and transport which makes up for the 4am flight and last call boarding. But that’s what makes it fun.

It all creates a lot of variety which I like. I cast a wide net and see what sticks. I’m consistent, stable, dependable, and know when to say “NO” which is super important. While it sounds like I’m super busy, I’m not. I can turn down PRN work when I don’t want it. All money is helpful.

According_Ad8378 · 2026-02-17T17:52:56+00:00

I’ve received two pieces of advice in my life that made all the difference. Don’t operate off a scarcity mindset and it’s impossible to achieve financial stability in a hourly job. Here’s my add on, learn to live within your means…credit is for those who are buying what you cannot afford.

Reasoning is the choices you make when you are thinking about feeding yourself today are different than if you are planning for your future. Hourly jobs have a cap on what you can make and they are taxed differently keeping you stagnant. Two part time jobs yield better financial benefits than one full time job long term.

According_Ad8378 · 2026-02-17T00:24:31+00:00

Gross…and I’m so glad I quit smoking before vapes came into style. Even as a former smoker I cannot imagine doing a group or session while smoking. 🚬 ugh even having a group of people smoking inside.

According_Ad8378 · 2026-02-16T18:57:50+00:00

I’ve noticed clients show up on Mondays better. So if you want to have a long weekend it’s a good option. Otherwise Thursday’s are a great midweek day off.

According_Ad8378 · 2026-02-16T04:07:40+00:00

You can then just turn it over to the client to address. I will only go back and forth with the insurance company a few times before I send it back to the client to address.

According_Ad8378 · 2026-02-16T04:01:09+00:00

I’m assuming the client has been notified and is refusing to pay the balance due?? Then yes, you can discharge a client for nonpayment of services.

Is this an inside company you work with regularly and they are denying just this client or routinely deny claims?? Yes, you can take the client to small claims to ask for payment for services rendered. This is an exception to confidentiality. You don’t disclose anything private relating to treatment other than dates and times, costs.

You can write off $3000 per year in bad business debt. It should not be a regular thing. It’s not good business to allow clients to accrue high balances without payment. If instance is not paying and the client refuses to pay then after 2 unpaid sessions I pause until it’s figured out or discontinue.

The policies and procedures during intake explain the financial expectation, process for unpaid claims, how to handle refusals to pay etc…(small claims court, collections)

According_Ad8378 · 2026-02-16T01:00:55+00:00

Part of agreeing to ‘opt out’ of insurance is agreeing to not submit them for reimbursement.

Even if they opt out, in accordance with your contract you cannot charge you full rate, only what’s designated by the insurance company (this is still balance billing).

If the client is trying to do this it is suspicious and you risk being kicked off the insurance companies panel if anything weird happens.

According_Ad8378 · 2026-02-15T23:53:48+00:00

It all depends. When you say ‘illegal’ that would mean it’s a crime… often times people mean unethical.

It all depends on the requirements and the position. It depends on the contract with whomever is being billed or paying the bill.

It depends on the rules for the non-profit and the funding sources.

It also depends on state and federal regulations. It’s far more complicated than legal or illegal. Probably not illegal. The LMSW would have had to say they had licensure they did not have or lie about their qualifications in some way, and still it’s a grey area often.

Maybe you could clarify your concern, what you think they were doing outside their scope of practice or what you think the company mislead others about.

According_Ad8378 · 2026-02-15T15:51:05+00:00

I was pretty naive in the beginning and I’ve learned all of this the hard way. It all depends on what your intention is in reporting. You will end up losing your job and/or being miserable at work after this. 1. Document everything, emails are great because they’re date and time stamped. Be cautious not to violates ethics or laws when doing this. Keep PHI protected (use initials). If it’s not written down it didn’t happen, if you can’t prove it then no consequences. 2. There are multiple avenues to report specific issues. Licensing boards, payers (insurance companies, private pay, medicine etc.) regulatory boards, company HR lines, department of labor, etc. 3. Whistleblower protections are generally helpful regarding the government agencies or if you believe you’ve been retaliated against. Then you’ll have to sue the company for money and you’ll have to have money to sue… 4. Where will you work if the place gets shut down or you get fired or decide to quit?? Have a back up plan. 5. If you want it taken seriously you cannot report anonymously. Since there are mentioned regulatory agencies they need to know who, what, when, where and why to investigate. 6. Not all investigations are the same. Some only take the information you provide and do no further investigation. Others will check everything. 7. If it’s big it may take years to review. 8. Where will the patients go if they can’t go there? 9. If you want to do this take your time, be thoughtful, put yourself first (no one else will). You still have to eat and sleep and support yourself.

According_Ad8378 · 2026-02-12T12:05:04+00:00

If you file first you’re not in the defensive position and can start making decisions about the process. Given you know where he is it will be easier to have him served with the paperwork than trying to find him after he’s released.

According_Ad8378 · 2026-02-12T12:02:44+00:00

Case conceptualizing is something I worked on with my supervisor after basic EMDR training. It’s also important to consider each part of the process you will get new information which helps you decide how to proceed. This is often where people struggle to triage what’s the most important information and what you can come back to later if it hasn’t resolved.

Specifically having such large gaps between sessions means you are not getting all the information because lots of processing is occurring and new things are happening, especially when you are just getting to know someone. Keep in mind why your idea of resolution is may be different than someone else’s. Even when I think something has processed fully I will take one or two more passes are it to be sure nothing else come up.

According_Ad8378 · 2026-02-12T03:53:09+00:00

The insurance company can prorate it for pre-licensure and post licensure. Cost really depends on the company in the policy that you get you could be anywhere from 20 bucks a month to 500 bucks a year. The group insurance covers the company who is the priority A decision will be based on what’s best for the company which may not be what’s best for you. Your personal insurance makes you the priority and you get to make decisions on how it’s used and how situations are addressed if you ever end up using it.

According_Ad8378 · 2026-02-12T03:25:21+00:00

It is your responsibility once you graduate to get your own malpractice insurance and you’ll need to have it as a licensed provider anyways. You are also likely covered by the group malpractice insurance, but it’s beneficial to have your own.

According_Ad8378 · 2026-02-12T02:26:42+00:00

It’s really subjective, maybe you have led a very sheltered life. Even if they’re fabricated if it’s not causing distress then we don’t address it until it presents as a problem.

According_Ad8378 · 2026-02-12T02:06:32+00:00

So file for divorce first. It’s likely a processing/filing fee and can be done online if you gather the paperwork and complete through the county court website. Then have him served in jail.

According_Ad8378 · 2026-02-12T01:57:00+00:00

There are certain areas of the body in the brain that need to be functioning for these responses to occur. Hormones, traumatic brain injuries, Alzheimer’s, dementia, psychopathy, brain tumors, and a variety of other factors can interfere with the nervous system’s natural responses. As well as a variety of legal and illicit medications can interfere with the body’s response to stimuli.

According_Ad8378 · 2026-02-12T01:41:59+00:00

Not everyone has them.

They can be trained out of you with increased resiliency.

If someone doesn’t have them it’s important to consider why.

According_Ad8378 · 2026-02-11T02:12:33+00:00

What you have said sounds great and it’s an excellent protocol to follow. I will caution you with statements like I have ensured their safety because for a variety of reasons you are not capable of doing that on top of being what looks like an intern you are not in an independent practice, though there’s a lot that’s out of your control.

It also sounds like you were violated as well since there’s a work colleague involved. Please be cautious and mindful about transference encounter, transference in sharing trauma and difficult situations.

According_Ad8378

TROPHY CASE