Center Institute

The day BCBS asked for their money back (and other stories of insurance madness)

When the BCBS of Montana sent letters out to just about every therapist in Montana asking them to pay back a large portion of the reimbursements they’d sent between July 2013 and July 2014, it wasn’t a joke. Yes this is 2015, and yes, they were talking about 2013. (Apparently they can go back that far.) They even said that they took “full responsibility” for their mistake, without intending any irony.

Man, it is something to see a room full of 50-therapists get their hackles up – and justifiably so. These are people who spend their life focusing on relationships that cultivate trust and healing. And the insurance company had reimbursed them for that time and effort. And now BCBS was asking them to pay back that money. Honestly, it is more complicated than that, but that is the short of it. (In my case, I never deposited any money BCBS sent me because they really should have been sending it to the client since I am out-of-network, but BCBS wanted me to go to my former clients and ask them to pay that reimbursement money back to me so I could send it to BCBS. You can be sure I was not about to do their dirty work for them.)

And it turns out, I am in a position where I can ignore them.

They can’t garnish future payments to me because there are no future payments coming from them for future claims. (This is what they are holding over all the in-network therapists: you pay us now or we will just take it out of your future payments). But I wasn’t so lucky years ago, when therapist were facing a different financial blow from insurance companies: allowable amounts DROPPED suddenly. That was the moment I knew I had to get off insurance panels.

I, just like all the other in-network therapists, submitted my claims for the visits I’d had with clients that month. A few weeks later, a check came in the mail along with an explanation of benefits. At first I didn’t understand why the numbers looked off. It seemed like less than I thought it would be. And then I saw the allowable amount had changed… The allowable amount had DECREASED by $10 per 60-minute session. I was confused and shocked. As I looked into it during the next several weeks, I learned that insurance companies can do that to you if you are a contracted provider. I also learned that providers in other fields of medicine had experienced increases in their allowable amount. All of this had basically come down from the American Medical Association reassigning “Relative Value Units” and placing more units with “procedural” codes such as removing a mole, doing surgery, etc. Therapists got the short end of that stick, with those RVUs coming out of the work WE do. Insurance companies took no responsibility for the move and blamed it entirely on the AMA. Really, I doubt that the insurance companies had no choice in this, but regardless, it made it crystal clear for me that being an in-network therapist was choosing to give up my own power over the financial end of my business.

So I left the networks. Some required 90-day notice. I’ve heard of some that require you to finish out your annual contract and won’t let you leave at just any point, so really I was lucky in some ways. That $10/hour pay cut was enough to make me open my eyes and take responsibility for my business’s financial well being.

Now, people ask me all the time how I’ve done what I’ve done in private practice. On April 15, I’ll be hosting a webinar where I will give you an inside look at my formula that allows me to do the kind of clinical work I believe in, while seeing only 12-clients a week (so I can also spend time supporting other therapists in their practices and still take every Friday off) all the while making more than my husband does working 40-hours a week as the financial guy at a non-profit. I will also lead you through a process to start getting really clear on what your practice could be for you and your clients. Specifically, I’ll share with you how I structure my pricing to make the numbers (that I choose) work for me and the life that I want.

Sign-up here to get the down-low on how to join in on the April 15th webinar. I look forward to “meeting” you!