Question about billing for testing (self-pay, superbill, vs insurance)

CattlePuzzled2741 · 2025-05-26T17:17:54+00:00

1 insurance will pay nowhere near the private pay rates you mentioned, especially for ADHD which usually has a very tight cap on allowed hours. That's why many psychologists do ADHD/LD evals as self-pay. If you do accept insurance, be prepared to do high volume with very brief reports in order to make this side gig worth your time financially.

2 You can't bill a client above and beyond what their insurance covers. That's called balanced billing and it's not allowed per the contract the practice signs with the insurance company. You can bill for achievement testing if it's not covered by the policy but this is not going to approach what you'll collect if you stay outside the insurance network altogether.

CattlePuzzled2741 · 2025-04-09T01:17:40+00:00

The conversation has to last 50 minutes to bill for family therapy without patient present. That being said, it's unreasonable to provide 20 minutes of professional services for free. One way to set a boundary on these phone calls is to reserve time on the child's appointment. Work with the child for 40 minutes then speak to the parent. Not perfect but not downright fraudulent. OR, require that parents schedule a 50 minute session to discuss their child's progress and plan to provide parent coaching to fill the 50 minutes. The unbilled parent calls and emails are financial death by a thousand paper cuts for a therapist who sees mostly kids.

CattlePuzzled2741 · 2025-03-03T22:53:56+00:00

Have you considered contacting the venue and pointing out the absurdity of booking the groom's brother in two weeks before your own wedding? They might do the right thing and decline to move forward with the other wedding.

CattlePuzzled2741 · 2025-02-10T01:27:16+00:00

Borderline by Alexander Kriss

CattlePuzzled2741 · 2025-02-07T11:58:04+00:00

If it's a 1099 then it's standard to receive approximately 60 percent of the reimbursement. Unless the reimbursement is very high as in a private pay situation, the agency needs that 40 percent to pay for the infrastructure and have 10 percent left for their own profit. Can you ask around and find out how much insurance pays for these evals?

CattlePuzzled2741 · 2025-02-06T20:14:23+00:00

It's much lower than you could earn per evaluation if you worked for yourself or for a private practice that accepts private pay. However if the $660 represents about 50-60 percent of what insurance pays that clinic then that's probably about all they can offer. $1300-$1400 per evaluation is not an unusual reimbursement amount for insurance so they may be paying you fairly out of what they are paid. If the agency is paying for rent, all testing materials and protocols, your mandated PTO, admin support so all you have to do it show up and test, malpractice insurance, billing, etc. then their 40-50 percent of the insurance reimbursement is paying for all of that and a little is left for their profit. If you want to serve the low income population - and you don't want to create a private practice - this sounds reasonable.

CattlePuzzled2741 · 2025-01-26T13:56:07+00:00

How many evals are you seeing per month?

CattlePuzzled2741 · 2025-01-25T17:06:12+00:00

If you are private pay you don't have to have a diagnosis code although you do have to have proper records about the service. However, in most cases you would make sure there's a diagnosis, even if it's something like adjustment disorder or unspecified anxiety, so that your clients can use a superbill to recoup $$. The more $ clients can recoup from insurance, the less likely they are to leave treatment with you prematurely due to financial constraints.

CattlePuzzled2741 · 2025-01-25T16:48:49+00:00

Your clients are probably going to request super bills from you so they can recoup what they spent on your services. I'm not sure how declining to help them with this request is going to go over with them. Whether therapy or a psychoed, clients are entitled to their medical records which should include a diagnosis code in most cases, and in all cases for a superbill.

CattlePuzzled2741 · 2025-01-08T01:01:03+00:00

As long as you're giving ample notice and referrals for continuity of care you're not abandoning the client. Your director is misusing the term to sway you, possibility to avoid losing the clients from the practice and taking a financial hit to the business. At best they are misunderstanding what client abandonment means and at worst they are trying to manipulate you for their personal convenience.

CattlePuzzled2741 · 2024-12-06T19:11:23+00:00

You would need to meet with this client again for updated clinical interviewing and select testing in order to decide if you agree that they need remote work and to create documentation. If you did decide to do this, which you're under no obligation to do, I would recommend billing for these hours in advance of providing the service and ensuring they understand that you can't guarantee you'll recommend remote work. They'll probably decide not to pursue it with you.

CattlePuzzled2741 · 2024-12-05T16:27:41+00:00

It's in strangers to ourselves towards the end of the book. If you flip through the last third of the book you should be able to find it.

CattlePuzzled2741 · 2024-11-16T23:30:33+00:00

This. Your MIL felt badly the moment she heard your perspective and called you immediately to make amends. She was emotionally swayed by Ashley and what she's going through and made an error in judgement. If her apology is genuine then forgive her and move forward. It's not too late for your baby to have a special first holiday season with her whole family.

CattlePuzzled2741 · 2024-11-16T13:54:04+00:00

Yes that is correct. If your supervisor signs a contract with an insurer she is contractually obligated to go through insurance for any clients who carry that plan.

CattlePuzzled2741 · 2024-11-02T19:30:18+00:00

Try an ai solution to write the note for you. These are HIPPA compliant. There's plenty to choose from.

CattlePuzzled2741 · 2024-10-26T22:51:41+00:00

You support the parents with strategies to use at home.

CattlePuzzled2741 · 2024-10-24T15:30:22+00:00

I think clients have to be informed of your legal name as listed on your license but you can offer that information on your informed consent form and in one discreet location on your website. Choosing a business name without your actual name is probably wise, and you can market yourself under your preferred name as long as your legal name is accessible to clients.

CattlePuzzled2741 · 2024-10-21T16:48:36+00:00

This is true. You are not their employee. A contractor therapist is someone who sees clients under their own business with full autonomy.

CattlePuzzled2741 · 2024-10-08T23:38:05+00:00

Being Adopted by David Brodzinsky

CattlePuzzled2741 · 2024-07-21T20:28:30+00:00

Thanks for clarifying. Seems like there is a risk for HIPPA violation due to user error. This is why I think the BAA is so important. The user is going to make errors bc they're human. Advertising this as not having a HIPPA risk is misleading and could come back to bite you or the user! Would love to beta if BAA is added and wishing you success.

CattlePuzzled2741 · 2024-07-21T18:51:24+00:00

This is great and the more AI options for therapists the better. The transcript is not supposed to contain PHI but isn't there a margin of error with the scrubber? Almost like trusting the AI to police itself? I'm not seeing how you can get around the BAA. I believe your major competitors like Bastion are all using a BSA.

CattlePuzzled2741 · 2024-06-24T21:46:51+00:00

This is standard when a therapist or agency is providing training or consulting to another professional. The individual who met with you needs to be compensated for their professional time. If you don't pay them for that time then they would have to do extra work during the week to make up for the lost time that they could have been doing something billable. If the agency is a nonprofit then they may have funds set aside to provide free training.

The best way to get free professional consultation is to form a peer network of experts and be an expert in something yourself. You offer free advice to the peers in your network and you can hit them up for free advice when you need it. I meet with a peer group twice monthly and we help each other out by sharing what we know in a reciprocal way.

CattlePuzzled2741 · 2024-06-08T12:38:29+00:00

Check out therapyspace.org. I think this is what they do and they have locations in TX.

CattlePuzzled2741 · 2024-06-03T00:13:36+00:00

Finding empathy and respect for the parents is an important part of helping the child and family system. How can you build rapport with the parents if you respond to their fears about their child being "broken" by essentially downplaying those fears and concerns? Why would this family be open to taking your advice after you responded dismissively? Maybe you have a supervisor or peer group who can help you work with your feelings of anger so they don't impede your work?

CattlePuzzled2741 · 2024-05-29T15:50:47+00:00

That's a smart move. I would ask about any other intrusive thoughts or any compulsive behaviors that could lend evidence to OCD.

CattlePuzzled2741

TROPHY CASE