Insurance Billing and Mental Health Deductibles

By Justin Gaines on August 11, 2021
Wallet dumping coins into an insurance-branded coin purse

Mental health deductibles can be extremely annoying, to say the least!

You have a new patient at your practice or clinic. You run the benefits and see that there is a $15 co-pay for your session. You let your patient know, collect the co-pay at the time of service, and bill the claim. Next week you do the same thing, and then the week after that too. Soon the claim comes back and, boom! There’s a deductible that applies to mental health that was not accounted for. Now you have to go back to your patient and request the balance of the rate. UGH! 

The above scenario is a direct result of a "bad insurance quote." There are simple steps you can take to minimize the damage from these misquotes over time and avoid those uncomfortable conversations with your patients.

For one, know that bad insurance quotes are an unfortunate part of insurance billing, especially for mental health providers. Benefits for mental health are often challenging to obtain and understand, because mental health coverage is a hybrid benefit—not primary care and not specialist. In many cases, the benefit for mental health is completely separate from the insurance’s standard health benefit; where the deductible would apply to standard medical care, it does not for mental health. 

These bad insurance quotes can happen whether you use a system or portal to verify benefits, or even call the insurer directly. Many insurers have reliable and accurate systems for verifying benefits (Optum’s Link, for example), so calling isn’t always necessary. More often than not, when you get a bad insurance quote the deductible for mental health will surely be involved. 

What can you do to prevent this from happening? First, if you are calling insurance to verify benefits, always ask if the deductible applies to mental health. If you use a system, be on the lookout for specific keywords or codes indicating the deductible does not apply. Some systems readily identify this for you and state whether the deductible applies to mental health in black and white. Others are more ambiguous and you’ll need to put on your detective cap to have absolute certainty. 

Second, no matter how you are verifying benefits, always submit your claims shortly after your session. If your benefit quote is incorrect, the EOB or ERA that will come back from the insurer will alert you to the issue quickly. And because you submitted your claim quickly, you’ll be able to identify these situations after one, two or three sessions as opposed to five or six.

These are just a few techniques you can build into your current billing system to ensure that your practice’s billing cycle is well managed. You’ll be able to identify these problems quickly, understand how to resolve them and, most importantly, be able to communicate clearly and confidently with your patients. 

The mental health deductible is a component of each of your patient’s insurance plans which, if not understood correctly, can cause big issues. Adopt the simple strategies above to ensure that you have the simplest and most efficient billing system for your practice!

* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.


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