Mental Health Billing: Can Counselors Balance Bill Clients?

If you are a mental health/behavioral health professional, working in private or group practice, you will have your work cut out for you. We want to help you with some quick tips and answers on mental health billing.

Perhaps you are wondering, can I bill a client for the balance?

We talked to the Senior Medical Biller at Thriveworks, Alicia Potts, and she gladly shared her knowledge with us.

Dilemma:

If I am a healthcare provider and my service fee is $150 per appointment, but the insurance company only pays 75$, can I charge the client/patient the balance?

Answer:

“If you are contracted with a particular insurance company, no. Legally, by law, you cannot charge that rate. You will have to break off the difference and follow the insurances’ rate for that particular service.”

Pros:

Being in network with an insurance company brings in more patients and clientele.

Cons:

Your rates are reduced.

Example:

For example, $65.00 is allowed, and the patient has a $20 co-pay, the insurance will pay everything minus the $20 dollar co-pay up to $65.00 (not in addition to the co-pay).

So, if my cash-rate is $150.00 – you will get the $20 co-pay from the patient, and the remainder (up to $65.00) from the insurance company. You cannot say to the patient, “You owe me an additional $65 bucks”.

Quick Tip

If you are out of network and do not have a contract with an insurance company, then you can bill the patient for the remainder. But if you have a contract, you are legally bound and cannot go over what they allow for that particular service.

Learn about the exciting benefits of opening a Thriveworks Counseling center in your area, here: Counseling Franchise.

Sincerely,

Your Friends at Thriveworks

Anthony Centore

Anthony Centore

Anthony Centore Ph.D. is Founder and CEO at Thriveworks--a counseling practice, focused on premium client care, with 240+ locations across the USA. He is Private Practice Consultant for the American Counseling Association, columnist for Counseling Today magazine, and Author of How to Thrive in Counseling Private Practice. Anthony is a multistate Licensed Professional Counselor and has been quoted in national media sources including The Boston Globe, Chicago Tribune, and CBS Sunday Morning.

Check out “Leaving Depression Behind: An Interactive, Choose Your Path Book” written by AJ Centore and Taylor Bennett."