therapist reimbursement rates
August 13, 2021 10:03 AM Subscribe
Is there somewhere I can look up reimbursement rates for therapy providers? Like how much insurance companies pay for services?
I'm trying to help someone evaluate a potential move. One of their concerns is that, moving from a city with a high cost of living to a lower COL area, their pay will go down significantly. I've made the point that the whole point of lower cost of living is that expenses are commensurately lower, but this person is not convinced, so I'm trying to help them get an idea of what they could expect their income to be. This person is a fee-for-service LISW. I've found rates for Medicare, but ideally I'd like to know about private insurers as well, especially big national ones like Cigna or Aetna. Broken down by state would be ideal, as well as by telehealth vs. in-person. I know this is probably information that insurers don't want being made public, but is there anything, even estimates, out there? The billing codes we'd be most interested in are 90791, 90832, 90834, 90837, and 90847.
I'm trying to help someone evaluate a potential move. One of their concerns is that, moving from a city with a high cost of living to a lower COL area, their pay will go down significantly. I've made the point that the whole point of lower cost of living is that expenses are commensurately lower, but this person is not convinced, so I'm trying to help them get an idea of what they could expect their income to be. This person is a fee-for-service LISW. I've found rates for Medicare, but ideally I'd like to know about private insurers as well, especially big national ones like Cigna or Aetna. Broken down by state would be ideal, as well as by telehealth vs. in-person. I know this is probably information that insurers don't want being made public, but is there anything, even estimates, out there? The billing codes we'd be most interested in are 90791, 90832, 90834, 90837, and 90847.
I'm super interested in other responses here because my understanding is that most private insurance contracts for therapists dictate that we can't share our reimbursement rates publicly. In my experience, there's no difference between reimbursement for a given billing code done via telehealth vs. in person. (But there's always this looming threat of insurance companies possibly ending coverage for telehealth--I think telehealth will ultimately be here to stay long-term, but insurance companies are gonna insurance company.)
They might think about keeping their current license active and maintaining a telehealth-only practice for clients in that state. So a thing to look at with places to move might be the laws about licensure in their current state and the target state.
And/or they might prioritize getting paneled with Medicaid, TriCare, etc.--agencies that provide public information about their fee schedules.
posted by theotherdurassister at 12:13 PM on August 13, 2021
They might think about keeping their current license active and maintaining a telehealth-only practice for clients in that state. So a thing to look at with places to move might be the laws about licensure in their current state and the target state.
And/or they might prioritize getting paneled with Medicaid, TriCare, etc.--agencies that provide public information about their fee schedules.
posted by theotherdurassister at 12:13 PM on August 13, 2021
One approach: Although forecasting their income might be important later, what if you start with general data about how much therapists make on average in different places?
Here are state-by-state data maps with information about the employment rates and salaries of marriage and family therapists.
Another approach: If this person is already provider with the big insurance companies, they might be able to provide this information. Reimbursement may change by zip code, unfortunately, if it is based on "usual and customary" fees for service. However, if there are a few zip codes they have in mind, they can probably call the insurers and ask for reimbursement rates for a specific billing code for a zip code.
posted by chesty_a_arthur at 12:37 PM on August 13, 2021 [1 favorite]
Here are state-by-state data maps with information about the employment rates and salaries of marriage and family therapists.
Another approach: If this person is already provider with the big insurance companies, they might be able to provide this information. Reimbursement may change by zip code, unfortunately, if it is based on "usual and customary" fees for service. However, if there are a few zip codes they have in mind, they can probably call the insurers and ask for reimbursement rates for a specific billing code for a zip code.
posted by chesty_a_arthur at 12:37 PM on August 13, 2021 [1 favorite]
No, you can not just call in the insurance company and ask - they won't tell you. I would join some professional groups on Facebook or LinkedIn and then ask there, probably inviting people to contact them privately since insurance company claim this is proprietary information. National groups might have some members in the right location. If they have already targeted a very specific location then look for local/regional groups as well.
They might also want to reach and ask more generally if there are any professional in the target area that might be willing to do a short phone call to answers questions about working in the new area. Once on the phone, you will probably get better answers than you would in a public forum or even via email.
posted by metahawk at 7:34 PM on August 13, 2021
They might also want to reach and ask more generally if there are any professional in the target area that might be willing to do a short phone call to answers questions about working in the new area. Once on the phone, you will probably get better answers than you would in a public forum or even via email.
posted by metahawk at 7:34 PM on August 13, 2021
No, you can not just call in the insurance company and ask - they won't tell you
You sure about that? Because I’ve done this many times and never had a problem. Although, to be fair, I was calling my own insurance provider. Not sure if you just can call random insurance companies you’re not a member of and start asking about rates. But yeah, any time I start looking for therapists, I always call my insurance company and ask for the maximum allowable rate for my area and for the type of therapist (psyd, lcsw, etc.) In fact I think they have to tell you. At very least, you’re going to find out when you get your first bill.
posted by panama joe at 5:56 AM on August 14, 2021
You sure about that? Because I’ve done this many times and never had a problem. Although, to be fair, I was calling my own insurance provider. Not sure if you just can call random insurance companies you’re not a member of and start asking about rates. But yeah, any time I start looking for therapists, I always call my insurance company and ask for the maximum allowable rate for my area and for the type of therapist (psyd, lcsw, etc.) In fact I think they have to tell you. At very least, you’re going to find out when you get your first bill.
posted by panama joe at 5:56 AM on August 14, 2021
This thread is closed to new comments.
As an aside, since it is a sore subject for me, I will say that it is one of the many ways that we in healthcare are disempowered and prevented from advocating on our own behalf. The general public is often unaware of such nuances as they are encouraged to direct their frustration for the healthcare industry toward doctors and nurses.
If you are curious - for smaller clinical practices, negotiation of contracted rates is a thing of the past. These days, insurers just throw us a (often insultingly low) fee schedule and say, 'Take it or leave it. You have no leverage to negotiate.' So, many clinicians in the area of interest may have the same fee schedule for a given insurer.
posted by aquamvidam at 11:34 AM on August 13, 2021 [2 favorites]