Insurance eligibility checks before a therapy intake

A new client's insurance turns out to be inactive, or the plan has a high deductible, and you find out when the claim comes back weeks later. Calling payers takes about 20 minutes per new client; at 8 new clients a month that's 160 minutes, plus an unpaid $130£98€116A$188C$184 intake whenever a policy has lapsed.

TherapyNotes' Electronic Billing charges 14¢ per electronic eligibility request, the same as a claim or ERA. Run one when a new client books and again before the intake to see whether coverage is active and what the payer returns about copay and deductible; call the payer only when the response leaves out mental health benefits or authorization rules. Tell the client their expected share before the first session. HIPAA: TherapyNotes says its BAA with you covers every feature.

An illustrative example built from typical figures, not a named business.

A psychologist in Atlanta on TherapyNotes Solo, in-network with four insurers, takes about 8 new clients a month at $130£98€116A$188C$184 for an intake.

About $150£113€134A$217C$212 a month of your time, for about $3£2€3A$4C$4 in eligibility requests. Cutting 15 minutes from each of 8 new-client checks saves 2 hours; if an hour of your time is worth $75£56€67A$108C$106 that's $150£113€134A$217C$212. Avoiding one $130£98€116A$188C$184 intake a month that would never be paid adds $130£98€116A$188C$184. The requests are 16 a month at 14¢; the Solo plan is $69£52€62A$100C$98 a month if you're not already on TherapyNotes.

1. 1Turn on Electronic Billing in TherapyNotes and complete enrollment with the payers you bill.
2. 2Collect the insurance card when the client books and run an eligibility request the same day.
3. 3Run a second check the day before the intake, and recheck every insured client at the start of the plan year.
4. 4Call the payer for anything the response doesn't show, such as a separate mental health plan, telehealth coverage or prior authorization, and note the call reference.
5. 5Tell the client their expected copay or deductible in writing before the first session; for self-pay clients, give the Good Faith Estimate the No Surprises Act requires.

• Active coverage isn't the same as covered services. Mental health benefits are sometimes run by a separate company, and the response may not show it.
• The 14¢ fee applies to every request, claim and ERA, so a practice billing 100 claims a month pays about $14£11€13A$20C$20 for those as well.
• Coverage can change mid-year when a client changes jobs. Recheck whenever a claim is denied for eligibility.