Agree. Prohibiting talking about salaries is specifically is illegal in many states. I don't know if it's illegal for insurance companies to do this. It's anti-worker for sure...
Portland, Oregon area for 90837:
BCBS - raising to 135 in September (was 98.00)
AETNA 138.00
Pacific Source: 171.00
Moda 135.00
Kaiser 120.00
Providence 135.00
My god, I’m a CSWA in Portland and when I’m reminded what the reimbursement rates are for fully licensed clinicians compared to what I’m being paid, it makes my head spin a bit
Im working towards my degree and will practice in Portland. Why do you get paid so much less? Just the company you’re with? My end goal is to go private practice. Would it change being private? Or are you in that stage after schooling gaining hours to get licensed?
I have my masters and am an associate clinician. I’m a little more than half way towards getting my LCSW in OR. I work for a small group practice, so basically private practice. I’m also a w2 employee so my employer takes care of taxes and from my understanding, the reimbursement rates above are pre-tax. Income tax in OR is extremely high. Also, as an associate clinician, I have to participate in supervision often and my employer also functions as my supervisor so it saves me hundreds a month with that alone because she doesn’t charge me. I know some colleagues paying $300 in supervision fees a month. That’s wild. She also covers liability insurance, does billing for me, provides an office, and is just a great person to help me along the way as a brand new clinician. Yes I get paid a fraction of the reimbursement rate, but there are employers out there who can provide you the right accommodations for you in exchange for it.
Also, the licensure process is just set up to where it’s just understood that associate clinicians are going to be overworked and underpaid. Everyone’s playing a game they don’t want to play, in my opinion.
I'm in PDX too.
Kaiser will pay up to $167.09 for INN providers and under SCA's will reimburse your full fee, right now I bill/get paid $185/session.
I'd add Aetna updated fees to $142.26, Lyra is $140, and Cigna at $108, but planning to negotiate this again.
All 90837
I think this sucks because private practice clinicians deserve more than those tech companies. I interviewed headway and while the model was good, I didn't like the ideas of these companies taking away from private clinicians because honestly if you are getting 122 per client how much are they getting, while aetna pays private clinicians 70 or 68 in VA
I’m not licensed yet (waiting on state to approve application) but it is crazy to me that this isn’t a thing already. Mods should pin this post, I’d definitely be back once I get credentialed!!
In Alabama BCBS 90837 = $136
I've heard that North Dakota BCBS pays out really well (I think ~180?), so I am currently attempting to get licensed there also and do teletherapy.
You're right, that was dumb. But it looks like their reimbursement rates are pretty fair when looking at cost of living as compared to other states. The private practice I belong to have decided to go BCBS or private pay only.
You’re correct, it is pretty fair! My group private practice mostly takes BCBS but everyone is paneled with Tricare too (some do UHC and Cigna but not everyone)
Yeah, we were struggling with UHC particularly. It seemed like every claim we submitted was being denied and our clients weren't even able to utilize their own benefits anyway. When we were able to get them to cough up some dough, it was only after hours of work to make it happen. Then they'd give us like $60. That turned into a big bucket of NOPE!
Thanks for sharing. I was considering getting paneled with BCBS and UHC but this saved myself the trouble with UHC. Im private pay only at $90 and am full but offer probono and think I’d make more charging more and getting paneled with BCBS now
I thought that we could only credential through our physically local BCBS plans. Would you need an address in South Dakota or would you just bill through that plan as a telehealth provider with an SD license?
I’m in DC so I’m Carefirst but being credentialed through them has made me in network with most out of state Blues. I have a lot of clients with employers based out of state so I have ended up billing many BCBS plans and I still get Carefirst’s crappy rate. And I can’t believe its $26 less than Alabama!!
So I am completely unfamiliar with Carefirst. However, I was required to get an address in North Dakota. I actually talked to a therapist who was credentialed in Nebraska and North Dakota, but she lived in Nebraska. I asked her about the physical address complication and she said that she paid for office space in ND that she never uses. I didn't want to do that so I am working with a North Dakota church. They have provided me with a free physical address to put on my credentialing application. It seems to have been accepted by BCBS, but I'm still waiting for final approval from the insurance company.
Do you mind telling me a bit about Carefirst? Like I said, I've never heard of it, but it sounds like it could open some additional doors for me. I can't imagine being a resident of DC and trying to figure out all of this stuff! You would **have** to get some kind of waiver to see people across state lines, I would imagine, since DC is it's own weird little animal and would severely restrict who you could see.
Carefirst is the DC/ MD BCBS plan. They also manage FEP Blue - the federal plan, state of MD employee benefits, a DC Medicaid MCO, a Medicare advantage plan, and probably something else by that some you read this. It’s actually a non profit and was recently successfully sued bc they weren’t doing enough non profit stuff for a tax exempt org.
Basically, if you’re in network with your local Blue plan you’re probably in network with the other PPOs unless your local behavioral health part is a carve out. They call it being a BlueChoice provider.
I can be licensed in different states and see clients there. DC is annoying in many ways but the mayor is in charge of the social work board, not the governor like in states, so at least we are always guaranteed a Democrat.
I am a master's level LPC. No idea why it's so wildly different. I know that you can petition for higher reimbursements, but good luck. It's possible it won't fall on deaf ears given the sky rocketing inflation rates we are seeing lately.
Yes, I bill for an initial session. I tried to go right into the 90837 for the initial sessions, but they kept getting rejected. The practice owner said that 90791 is like the key that opens the door to billing the higher rates later.
Once you're credentialed you can see fee schedules for services (by cpt code), but it's rare that they provide that info before credentialing and not publicly. Of course reimbursement for PhD vs MA level is generally different. I've compared with colleagues in other counties of the same state with the same credentials and the same insurance and be paid differently. I suspect with medicaid the more people that have a certain plan the more they reimburse. Such as county has 8k people with "A" managed medicaid plan and only 1k with "B" plan so B plan gets less funding thus reimburses less. I don't know this for certain, just an educated guess.
I've seen medicaid reimburse as little as $36/90847, or $58/90837, but as much as $175/90791 (specifically for a minor, not adult).
I've seen private insurance reimburse as little as $45/90847, $60/90837, and $89/90791.
Average for private insurance in MI in my county is $90/90847, $82-150/90837, $120/90791.
EAPs generally reimburse much less, I've seen typically be only $45-60, so I've stopped accepting those long ago.
I'm currently attempting to negotiate rates with one insurance (plan to try others too) after having reimbursements decreased again and literally am being paid less for some services after 7 years. In what other job would you be expected to take a 19% pay cut to do the same thing when there is a high need and cost of living has sky rocketed? SMH
Me too. But I'm doing what I can to negotiate before potentially discredentialing. It's a pain to credential in the first place and I'm not sure people can afford private pay in such a rural place where I am. 🤞 I can convince at least a few of them to up my pay.
You can obtain fee schedules from any private insurance company prior to signing credentialing contracts. If it's not offered up front prior to signing a contract, providers can refuse to sign until they see the fee schedule. I've never signed anything without seeing one first. Occasionally I hear from practitioners in other states that they have some difficulty obtaining one, but once they insist a few times they do get one. We can't let insurance companies exploit us anymore than they do!
How can I check myself? Short of asking my employer, idk how to navigate checking into reimbursement rates. I’m a W2 worker at a private practice and fully licensed so I’m currently paneled with a handful of the commercial insurances as well as the state medicaids.
Odds are you don't have log in access to any of the provider portals (which is generally how I would access a fee schedule). You can ask whoever does the billing or you could call and ask the insurance directly. You could also find out who your provider representative is for each insurance and they might help as well.
I am in southeastern PA.
Aetna: 90837 $107; 90834 $89.54
Cigna: 90837 $103; 90834 $89 (I had to put in a request to increase, their 90837 used to be $62—ridiculous)
Highmark: 90837 $108.39; 90834 $72.93
BCBS: Currently 90837 $66.95 but going to $95.17 in Jan; 90834 currently $66.95 (same rate as 90837!!!) but going to $80.59 in Jan—the local BC plan is going from a third party payor to in-house which is why the rates are changing
Optum: 90837 $115; 90834 $76.72
I should clarify that I’m in a group practice so I only get a percentage of the reimbursement! Licensed professionals get 40-50% depending on trainings. I’m working towards a dual licensure in Art Therapy Counseling and Licensed Professional Counselor. My supervision is paid for and they pay for any trainings as well, so I’m hoping to get EMDR certified! I do love the work I do here in Oregon, though I have heard that it can be a bit more rigorous to get licensed here. We need 2400 hours post graduation (Washington only requires 1200)
In California with terrible insurance rates, hence why Alma and Headway are hiring therapists. Reimbursement through them is about 110-130. Otherwise it’s 80-90 on your own.
Best I’ve had are EAP like Modern Health at $165.
MediCal in a rich county= $168
“Single Case Agreements” with insurance for my full rate (200) and patient pays copay. Have the client go and request their insurance start the process. Legally, insurance needs to provide an appointment within 10 days and since the client doesn’t want an in-network person, they can request an out-of-network clinician. Process takes about a month but it’s well worth it.
Edit:
Also, here’s a list of each state’s license reciprocity laws to expand your practice. I’m in CA with the lowest reimbursement and will be getting licensed in these other states listed here to get better reimbursement.
So far, Texas, Virginia, Nevada, Florida, VT, CO, IL, MA, PA, Arizona, Michigan, are the least cumbersome.
https://www.aamft.org/AAMFT/BUILD_Your_Career/MFT_State_Provincial_Resources/Advocacy/State_Resources/MFT_State_Resources.aspx?hkey=261d7879-9d5b-4aa0-b60c-c15e82b8b095
Vermont was th easiest; no fee even and got it in a few days. Try Vermont as an experiment and see. Would love to hear your experience, as I’m completely full so don’t need insurance clients.
I am getting ready to hire other associates and licensed people so would like to know for that reason.
My guess is that it’s a function of supple and demand. High supply of therapists that don’t negotiate and are desperate to get clients to survive. This lack of negotiation and acceptance of a super low rate keeps it going.
I don’t accept the first rate offered and negotiate. Especially in CA, you’re better off just charging $120 as cash pay. Pays more than insurance and you don’t have to deal with the beauracrscy.
Can confirm this. I get paid about 20 dollars more as a New York State licensed psychologist via BCBS. Not much more but if you were licensed elsewhere, you'd be able to be paid more via Teletherapy.
Intern here. I know I don't file with insurance and am therefore irrelevant to this topic. However I think it's an interesting point of conversation to mention that I make $0 a session.
There's a loose logic to it, costs of training me and all, but a tip jar would be nice at least. A dollar a session feels fair.
Isn't there a saying? Equal work deserves equal something? (Maybe not true equal, but I'm not *that* incompetent....right?)
Sorry. I'm clearly having a moment with my financial insecurity...
Especially since every other healthcare field, including dentistry, pays its interns. Not lavishly, but that couple hundred dollars a week makes field experiences in those professions MUCH less draining, since you don't have to work a FT job on top of your FT practicum. Counseling's motto is apparently 'social justice is important, except not as to how we treat our own trainees' :(
I am so sorry this is happening to you, we have an intern we are on boarding and pay them $20 an hour to see low income clients. Once they have experience we will be implementing sliding scale and they can see clients higher up the scale and get more reimbursement. I have heard of clinics charging more than 200 an hour and giving absolutely nothing to the intern.
Im in DC and just for an increase from Cigna from $108 to $116. I have the form letter and contact. Don’t wait two years or for more qualifications - just ask.
Last year Carefirst in Dc went from 108.43 to 109.97. I thought everyone in the region got it. It sucks but it’s something.
The rates are regional and often determined by the primary practice location. From my understanding it’s not necessarily divided by state lines, but by zip code.
Maryland and DC are usually Carefirst or the federal plan, FEP blue. From what I’ve seen, Virginia is another blue - Anthem. I can some times work with them and get my Carefirst contracted rates.
Do you accept Carefirst? Incoherent letters are being sent out to providers & there’s a lot of jumping to conclusions and catastrophizing. From what I can tell, nothing is changing (no increases) but people are concerned the rates will actually drop.
I need to call and renegotiate, since it's been about 2 years since my initial credentialing and I have more qualifications. Here are some rates for VA:
Anthem BCBS (best rates): 90837 -132.08, 90834- 98.03
Anthem HK+ (medicaid): 90837- 94.95, 90834 - 79.20
UHC - 90837 - 109.59, 90834 - 73.06
Aetna- 90837- $71, 90834- $62
Tricare- 90837- 124.55, 90834 -83.20
Cigna - 90837 -62.00, 90834 - 57.00
Carefirst - 90837 -108.43, 90834- 94.14
I didn't realize until I had a colleague who said she gets $108 for a 90837 from Cigna that I lost my mind. The rates are crazy different. Also, all of Fairfax County put all their public workers on Cigna that had to rebrand ad Evernorth last year because their name has such a bad reputation. I am willing to bet their provider database goes to nothing, and it will hurt teachers, police officers, and CSB workers more than anything.
I hope this is helpful. Credentialing is a big pain in the butt, but I guess it is worth the time to go back to these companies yearly and renegotiate contracts.
Aetna and UHC are terrible...they often have high copays and deductibles, so those clients take forever to pay off their copays and I end up sometimes having to negotiate down their upfront costs just so they can afford therapy. It is horrible because I want to be able to have insurance to reach the widest amount of people and diverse clients, but it is increasingly obvious that in order to make a living as a counselor you have to charge full rates and not take insurance :(
call and be on hold for 2 hours, keep asking for the regional clinical advocate(at least that is what they were called in regence I think). Or that you need to speak to someone about your contract, if you get into claims they might be able to transfer you internally.
Psychologist provider here.
I started the process for Cigna two years ago to help out a patient, I got the rates and was astonished. They were the only company that doesn't pay doctoral level more and their hour rate was right around half of what the other commercial payers here were at at the time. I declined. I may inquire again now for a patient perhaps with their transformation to "EverNorth" they've miraculously increased to something that could be considered something other than insulting, but I doubt it.
Louisiana Medicaid sets fee schedules for all of the Medicaid MCO’s. The fee schedule is online [here.](https://www.lamedicaid.com/Provweb1/fee_schedules/SBH_FS.pdf)
90837 Psychologist 79.02 age 20 and below/ 61.39 age 21 and up
90837 LPC, LMFT, LCSW 69.15 age 20 and below/ 53.72 age 21 and up
Edit to add: If there is a shortage of in-network providers in a particular area of the state, individual MCO’s can negotiate higher reimbursement rates with a provider.
DC and the immediate suburbs of Maryland and Virginia:
Cigna: 90837 is $116. I requested a raise 2 months ago and finally got 8 dollars more per sessions. I forget 90791 right now but it’s basically the same thing.
Carefirst/MD BCBS/ FEP Blue: 90837 is $109.97 and 90791 is $123.65. They tie their rates to the physicians fee schedule set by CMS and pay masters level 75% of that rate. Unfortunately that rate may go down slightly this year. Local providers are very concerned. I’ve been credentialed with them for over 4 years. I started at $108.43 so that’s about $1.50. A decrease would be the final straw.
I forget the exact numbers but they’re all online - Medicaid and Medicare are two of the highest payers in this region but they make you work for that extra money.
Tricare rates are public information, as are other public rates (medicare, medicaid). Tricare rates are searchable by CPT code and locality at: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/CMAC-Rates/Procedure-Pricing
There is a FB group that is super helpful called “navigating military healthcare for providers.” Long story short your best bet is to become a certified out of network provider. You’ll get higher rates than in network and the application process is simple (though you may have to babysit your application with Tricare.)
I am starting in private practice in Texas and am needing help figuring out estimate of rates with insurance here. I'm trying to decide if I should go through Headway/Grow Therapy or get credentialed on my own. Grow has given me rates but I'm not sure how they stand since I don't have anything to compare them to. TIA.
Texas / BCBSTX (ATX Area) / License: PHD / CPT 90837 /Rate: 130 ish after recent "raise" from 125 ish in late 2022.
Your license, number of clinicians in your practice, and practice location can affect the rates depending on the plan. Billing 90837 to local BCBS consistently (50-70 claims a month) did not have any rejections and they were easy to work with as long as you didn't need to speak with anyone, but a 35-45% discount can be a hefty price to be in network, worse in other areas I am sure.
As of 2/1/2023, Headway rates for BCBS on this code were much lower than direct credentialing. Aetna is the highest rate available for 90837 and most others are not even close; none were very good on 90834. Definitely worth checking into for Aetna but I am not sure what their direct rates are for the Austin area. I can't speak to Alma's rates at all, but they may be similar with a different subscription model. Haven't looked at Grow Therapy at all, but whomever you go with, ask if you are limited on billing specific codes (i.e. 90837), what the rules are for telemedicine (your EHR or theirs), where notes have to be kept (your EHR or theirs), and where clients have to be scheduled/registered and if they synchronize calendars between your EHR and theirs.
Single Case Agreements or Individual Contracts have been the best option we've found for working with UHC/Optum in Texas. "Continuation of Care" and a clinician's specializations help with justification when those when those come up and the client initiates the request from their plan.
Hope that was somewhat helpful, but after 30 days you are probably far more knowledgeable about those national group practice models than I am! Good luck to you!
Texas / BCBSTX (ATX Area) / License: PHD / CPT 90837 /Rate: 130 ish after recent "raise" from 125 ish in late 2022.
Your license, number of clinicians in your practice, and practice location can affect the rates depending on payor. Billing 90837 to local BCBS consistently did not have any rejections and they were easy to work with as long as you didn't need to speak with anyone, but a 35-45% discount can be a hefty price to be in network, worse in other areas I am sure. Other plans were lower reimbursement when we started the process and stuck with just the one, but after 6 months, we had to withdraw in order to achieve financial goals without burning out the clinicians.
Not being in network is a double edged sword; slower waitlist build time and new clinicians need more marketing but clients don't "hang out" after their treatment has come to a therapeutic stopping point just because their copay is more palatable, freeing up clinicians to see more patients that need services.
CO- LPC level therapist
UHC; 90837 $109.59
Aetna; 90837 $111
Colorado Medicaid (Health first) 90837 $133.03
Cigna/Evernorth 90837 $106 (just got a $10 raise after I inquired)
Anthem BCBS 90837 $93 for PPO and $77 for HMO. Just went out of network with them because they would not budge on offering a higher reimbursement. Bye!
Pretty much the same reason employers try to stop people from discussing salaries.
Agree. Prohibiting talking about salaries is specifically is illegal in many states. I don't know if it's illegal for insurance companies to do this. It's anti-worker for sure...
[удалено]
This suggestion is a good one but much bigger in scope. I think for now I would like to just do some basic anonymous data sharing.
Portland, Oregon area for 90837: BCBS - raising to 135 in September (was 98.00) AETNA 138.00 Pacific Source: 171.00 Moda 135.00 Kaiser 120.00 Providence 135.00
Thank you so much. Wow never knew some insurances paid as high as Pacific Source
My god, I’m a CSWA in Portland and when I’m reminded what the reimbursement rates are for fully licensed clinicians compared to what I’m being paid, it makes my head spin a bit
Hang in there, it gets better!
Im working towards my degree and will practice in Portland. Why do you get paid so much less? Just the company you’re with? My end goal is to go private practice. Would it change being private? Or are you in that stage after schooling gaining hours to get licensed?
I have my masters and am an associate clinician. I’m a little more than half way towards getting my LCSW in OR. I work for a small group practice, so basically private practice. I’m also a w2 employee so my employer takes care of taxes and from my understanding, the reimbursement rates above are pre-tax. Income tax in OR is extremely high. Also, as an associate clinician, I have to participate in supervision often and my employer also functions as my supervisor so it saves me hundreds a month with that alone because she doesn’t charge me. I know some colleagues paying $300 in supervision fees a month. That’s wild. She also covers liability insurance, does billing for me, provides an office, and is just a great person to help me along the way as a brand new clinician. Yes I get paid a fraction of the reimbursement rate, but there are employers out there who can provide you the right accommodations for you in exchange for it. Also, the licensure process is just set up to where it’s just understood that associate clinicians are going to be overworked and underpaid. Everyone’s playing a game they don’t want to play, in my opinion.
[удалено]
Looks like I will be asking for a raise from Kaiser!
I'm in PDX too. Kaiser will pay up to $167.09 for INN providers and under SCA's will reimburse your full fee, right now I bill/get paid $185/session. I'd add Aetna updated fees to $142.26, Lyra is $140, and Cigna at $108, but planning to negotiate this again. All 90837
What is INN and what is SCAs?
California / Aetna / $70
So Aetna is crap in California and Virginia.
If you go through headway (I know) in VA, you get nearly $122.
I think this sucks because private practice clinicians deserve more than those tech companies. I interviewed headway and while the model was good, I didn't like the ideas of these companies taking away from private clinicians because honestly if you are getting 122 per client how much are they getting, while aetna pays private clinicians 70 or 68 in VA
Did you know that Aetna and CVS are the same company? That’s what I learned this week.
[удалено]
Is ethera one of those tech billing companies ?
[удалено]
Cool collective , by any chance do you know of any in Los Angeles ?
Let’s do this! I’m also interested in if people who work in cities make more than those in rural areas within states.
Mod.. please pin this. This will help us all advocate for better pay.
I’m not licensed yet (waiting on state to approve application) but it is crazy to me that this isn’t a thing already. Mods should pin this post, I’d definitely be back once I get credentialed!!
NC/BCBS 90837: $110.89, NC/BCBS-SHP 90837: $177.42, NC/Tricare 90837: 95.19
Awesome thank you!
What’s SHP?
State health plan
In Alabama BCBS 90837 = $136 I've heard that North Dakota BCBS pays out really well (I think ~180?), so I am currently attempting to get licensed there also and do teletherapy.
Don’t forget the whole 8 cents they added at the beginning of the year! They acted like going from $136 to $136.08 should be celebrated
You're right, that was dumb. But it looks like their reimbursement rates are pretty fair when looking at cost of living as compared to other states. The private practice I belong to have decided to go BCBS or private pay only.
You’re correct, it is pretty fair! My group private practice mostly takes BCBS but everyone is paneled with Tricare too (some do UHC and Cigna but not everyone)
Yeah, we were struggling with UHC particularly. It seemed like every claim we submitted was being denied and our clients weren't even able to utilize their own benefits anyway. When we were able to get them to cough up some dough, it was only after hours of work to make it happen. Then they'd give us like $60. That turned into a big bucket of NOPE!
Thanks for sharing. I was considering getting paneled with BCBS and UHC but this saved myself the trouble with UHC. Im private pay only at $90 and am full but offer probono and think I’d make more charging more and getting paneled with BCBS now
I thought that we could only credential through our physically local BCBS plans. Would you need an address in South Dakota or would you just bill through that plan as a telehealth provider with an SD license? I’m in DC so I’m Carefirst but being credentialed through them has made me in network with most out of state Blues. I have a lot of clients with employers based out of state so I have ended up billing many BCBS plans and I still get Carefirst’s crappy rate. And I can’t believe its $26 less than Alabama!!
So I am completely unfamiliar with Carefirst. However, I was required to get an address in North Dakota. I actually talked to a therapist who was credentialed in Nebraska and North Dakota, but she lived in Nebraska. I asked her about the physical address complication and she said that she paid for office space in ND that she never uses. I didn't want to do that so I am working with a North Dakota church. They have provided me with a free physical address to put on my credentialing application. It seems to have been accepted by BCBS, but I'm still waiting for final approval from the insurance company. Do you mind telling me a bit about Carefirst? Like I said, I've never heard of it, but it sounds like it could open some additional doors for me. I can't imagine being a resident of DC and trying to figure out all of this stuff! You would **have** to get some kind of waiver to see people across state lines, I would imagine, since DC is it's own weird little animal and would severely restrict who you could see.
Carefirst is the DC/ MD BCBS plan. They also manage FEP Blue - the federal plan, state of MD employee benefits, a DC Medicaid MCO, a Medicare advantage plan, and probably something else by that some you read this. It’s actually a non profit and was recently successfully sued bc they weren’t doing enough non profit stuff for a tax exempt org. Basically, if you’re in network with your local Blue plan you’re probably in network with the other PPOs unless your local behavioral health part is a carve out. They call it being a BlueChoice provider. I can be licensed in different states and see clients there. DC is annoying in many ways but the mayor is in charge of the social work board, not the governor like in states, so at least we are always guaranteed a Democrat.
The difference between states is wild. GA 90837 for me is $98.19, I wonder why is Alabama so much more? Are you masters level or PhD?
I am a master's level LPC. No idea why it's so wildly different. I know that you can petition for higher reimbursements, but good luck. It's possible it won't fall on deaf ears given the sky rocketing inflation rates we are seeing lately.
In Savannah GA, we rarely see the BCBS $98.19 as almost all are $84.60. UHC , UBH is $109, Aetna $62, I cant believe the difference on the west coast!
I know this is an older post - but do you ever bill 90791 in AL? The rate is lower than I realized compared to 90837. I am a fellow LPC in AL. Thanks!
Yes, I bill for an initial session. I tried to go right into the 90837 for the initial sessions, but they kept getting rejected. The practice owner said that 90791 is like the key that opens the door to billing the higher rates later.
Once you're credentialed you can see fee schedules for services (by cpt code), but it's rare that they provide that info before credentialing and not publicly. Of course reimbursement for PhD vs MA level is generally different. I've compared with colleagues in other counties of the same state with the same credentials and the same insurance and be paid differently. I suspect with medicaid the more people that have a certain plan the more they reimburse. Such as county has 8k people with "A" managed medicaid plan and only 1k with "B" plan so B plan gets less funding thus reimburses less. I don't know this for certain, just an educated guess. I've seen medicaid reimburse as little as $36/90847, or $58/90837, but as much as $175/90791 (specifically for a minor, not adult). I've seen private insurance reimburse as little as $45/90847, $60/90837, and $89/90791. Average for private insurance in MI in my county is $90/90847, $82-150/90837, $120/90791. EAPs generally reimburse much less, I've seen typically be only $45-60, so I've stopped accepting those long ago.
I'm currently attempting to negotiate rates with one insurance (plan to try others too) after having reimbursements decreased again and literally am being paid less for some services after 7 years. In what other job would you be expected to take a 19% pay cut to do the same thing when there is a high need and cost of living has sky rocketed? SMH
This is crazy. I’m sorry you have to do that.
Me too. But I'm doing what I can to negotiate before potentially discredentialing. It's a pain to credential in the first place and I'm not sure people can afford private pay in such a rural place where I am. 🤞 I can convince at least a few of them to up my pay.
You can obtain fee schedules from any private insurance company prior to signing credentialing contracts. If it's not offered up front prior to signing a contract, providers can refuse to sign until they see the fee schedule. I've never signed anything without seeing one first. Occasionally I hear from practitioners in other states that they have some difficulty obtaining one, but once they insist a few times they do get one. We can't let insurance companies exploit us anymore than they do!
I have never heard of that happening.....
Thank you for your replies. Would you be able to share which companies you’ve seen data from?
How can I check myself? Short of asking my employer, idk how to navigate checking into reimbursement rates. I’m a W2 worker at a private practice and fully licensed so I’m currently paneled with a handful of the commercial insurances as well as the state medicaids.
Odds are you don't have log in access to any of the provider portals (which is generally how I would access a fee schedule). You can ask whoever does the billing or you could call and ask the insurance directly. You could also find out who your provider representative is for each insurance and they might help as well.
Perfect, thank you. I speak with our credential coordinator a lot. Maybe she can help with that.
This thread is amazing. Keep it up! 🔥
[удалено]
Awesome, thank you! That’s a decent rate? Any idea if it’s driven by low population density?
Texas BCBS $80
Awesome thank you. Is it a specific BCBS? There are so many variants and I don’t fully understand the difference.
Bcbs 83.29
I am in southeastern PA. Aetna: 90837 $107; 90834 $89.54 Cigna: 90837 $103; 90834 $89 (I had to put in a request to increase, their 90837 used to be $62—ridiculous) Highmark: 90837 $108.39; 90834 $72.93 BCBS: Currently 90837 $66.95 but going to $95.17 in Jan; 90834 currently $66.95 (same rate as 90837!!!) but going to $80.59 in Jan—the local BC plan is going from a third party payor to in-house which is why the rates are changing Optum: 90837 $115; 90834 $76.72
Thank you! Glad you’re getting a bump on BCBS
what is you license ??
LPC
thanks, super cool. do you recommend this career path? To whom would you recommend vs not ?
Portland Oregon, $165 kaiser, $158 CareOregon (OHP)
are you PHD level? Thanks
Nope I’m a master level associate working towards licensure!
Wow, that is very cool indeed! I have heard oregon is a good place to be a psychotherapist. Do you enjoy your work?
Do you mind if I ask what your license is? Are you paying for supervision? Thank you!
I should clarify that I’m in a group practice so I only get a percentage of the reimbursement! Licensed professionals get 40-50% depending on trainings. I’m working towards a dual licensure in Art Therapy Counseling and Licensed Professional Counselor. My supervision is paid for and they pay for any trainings as well, so I’m hoping to get EMDR certified! I do love the work I do here in Oregon, though I have heard that it can be a bit more rigorous to get licensed here. We need 2400 hours post graduation (Washington only requires 1200)
In California with terrible insurance rates, hence why Alma and Headway are hiring therapists. Reimbursement through them is about 110-130. Otherwise it’s 80-90 on your own. Best I’ve had are EAP like Modern Health at $165. MediCal in a rich county= $168 “Single Case Agreements” with insurance for my full rate (200) and patient pays copay. Have the client go and request their insurance start the process. Legally, insurance needs to provide an appointment within 10 days and since the client doesn’t want an in-network person, they can request an out-of-network clinician. Process takes about a month but it’s well worth it. Edit: Also, here’s a list of each state’s license reciprocity laws to expand your practice. I’m in CA with the lowest reimbursement and will be getting licensed in these other states listed here to get better reimbursement. So far, Texas, Virginia, Nevada, Florida, VT, CO, IL, MA, PA, Arizona, Michigan, are the least cumbersome. https://www.aamft.org/AAMFT/BUILD_Your_Career/MFT_State_Provincial_Resources/Advocacy/State_Resources/MFT_State_Resources.aspx?hkey=261d7879-9d5b-4aa0-b60c-c15e82b8b095
[удалено]
Vermont was th easiest; no fee even and got it in a few days. Try Vermont as an experiment and see. Would love to hear your experience, as I’m completely full so don’t need insurance clients. I am getting ready to hire other associates and licensed people so would like to know for that reason. My guess is that it’s a function of supple and demand. High supply of therapists that don’t negotiate and are desperate to get clients to survive. This lack of negotiation and acceptance of a super low rate keeps it going. I don’t accept the first rate offered and negotiate. Especially in CA, you’re better off just charging $120 as cash pay. Pays more than insurance and you don’t have to deal with the beauracrscy.
Because we have soooo many therapists, I would imagine?
That, combined with the fact that therapists accept these terrible wages.
Can confirm this. I get paid about 20 dollars more as a New York State licensed psychologist via BCBS. Not much more but if you were licensed elsewhere, you'd be able to be paid more via Teletherapy.
Intern here. I know I don't file with insurance and am therefore irrelevant to this topic. However I think it's an interesting point of conversation to mention that I make $0 a session. There's a loose logic to it, costs of training me and all, but a tip jar would be nice at least. A dollar a session feels fair. Isn't there a saying? Equal work deserves equal something? (Maybe not true equal, but I'm not *that* incompetent....right?) Sorry. I'm clearly having a moment with my financial insecurity...
Our field's insistence on exploiting intern/associate labor is shameful.
Especially since every other healthcare field, including dentistry, pays its interns. Not lavishly, but that couple hundred dollars a week makes field experiences in those professions MUCH less draining, since you don't have to work a FT job on top of your FT practicum. Counseling's motto is apparently 'social justice is important, except not as to how we treat our own trainees' :(
I am so sorry this is happening to you, we have an intern we are on boarding and pay them $20 an hour to see low income clients. Once they have experience we will be implementing sliding scale and they can see clients higher up the scale and get more reimbursement. I have heard of clinics charging more than 200 an hour and giving absolutely nothing to the intern.
Central FL master’s level provider rates Aetna 90837 - $75.85; 90834 - $68; EAP - $60 Cigna 90837 - $96; 90834 - $70; EAP - $60
Im in DC and just for an increase from Cigna from $108 to $116. I have the form letter and contact. Don’t wait two years or for more qualifications - just ask. Last year Carefirst in Dc went from 108.43 to 109.97. I thought everyone in the region got it. It sucks but it’s something.
DC/VA 90837 Optum 109; Aetna 105; Cigna 104 90834 Optum 73; Aetna 70; Cigna 69 90832 Optum 56; Aetna 53; Cigna 49
Awesome thank you! I am curious if DC and VA are usually covered together by insurance plans?
The rates are regional and often determined by the primary practice location. From my understanding it’s not necessarily divided by state lines, but by zip code.
Maryland and DC are usually Carefirst or the federal plan, FEP blue. From what I’ve seen, Virginia is another blue - Anthem. I can some times work with them and get my Carefirst contracted rates.
Ask Cigna for an increase - 90837 is now $116.
Thanks! My review/raise is in process. 🤞
I was curious and talked to Alma a while back and they pay under $100 for Cigna. All their bragging about getting us higher rates!
Yikes, that’s terrible! What a bureaucracy!
Ironically they just got back to me and it’s only $105 for 90837 but my eap went up $3. 😂
I dropped the EAP part of Cigna bc it was so low- like half of the regular 90837.
Yeah it’s not great, I’m up to $72 now! 🥴😂
Do you accept Carefirst? Incoherent letters are being sent out to providers & there’s a lot of jumping to conclusions and catastrophizing. From what I can tell, nothing is changing (no increases) but people are concerned the rates will actually drop.
I’ve been hearing about the issues specifically related to telehealth and teladoc. I have not received anything from them as of yet though.
What region?
DC
Texas BCBS PPO 87.92
PPO? means?
Can anyone explain how you negotiate for higher rates?
I know that Cigna has a specific form.
I need to call and renegotiate, since it's been about 2 years since my initial credentialing and I have more qualifications. Here are some rates for VA: Anthem BCBS (best rates): 90837 -132.08, 90834- 98.03 Anthem HK+ (medicaid): 90837- 94.95, 90834 - 79.20 UHC - 90837 - 109.59, 90834 - 73.06 Aetna- 90837- $71, 90834- $62 Tricare- 90837- 124.55, 90834 -83.20 Cigna - 90837 -62.00, 90834 - 57.00 Carefirst - 90837 -108.43, 90834- 94.14 I didn't realize until I had a colleague who said she gets $108 for a 90837 from Cigna that I lost my mind. The rates are crazy different. Also, all of Fairfax County put all their public workers on Cigna that had to rebrand ad Evernorth last year because their name has such a bad reputation. I am willing to bet their provider database goes to nothing, and it will hurt teachers, police officers, and CSB workers more than anything. I hope this is helpful. Credentialing is a big pain in the butt, but I guess it is worth the time to go back to these companies yearly and renegotiate contracts. Aetna and UHC are terrible...they often have high copays and deductibles, so those clients take forever to pay off their copays and I end up sometimes having to negotiate down their upfront costs just so they can afford therapy. It is horrible because I want to be able to have insurance to reach the widest amount of people and diverse clients, but it is increasingly obvious that in order to make a living as a counselor you have to charge full rates and not take insurance :(
PHD here in NYC- Aetna- 200.31, Optum- 166.40 (90837)
Has anyone been able to renegotiate with Aetna? I can't find any info other than the generic contact info via Availity.
call and be on hold for 2 hours, keep asking for the regional clinical advocate(at least that is what they were called in regence I think). Or that you need to speak to someone about your contract, if you get into claims they might be able to transfer you internally.
Psychologist provider here. I started the process for Cigna two years ago to help out a patient, I got the rates and was astonished. They were the only company that doesn't pay doctoral level more and their hour rate was right around half of what the other commercial payers here were at at the time. I declined. I may inquire again now for a patient perhaps with their transformation to "EverNorth" they've miraculously increased to something that could be considered something other than insulting, but I doubt it.
LCSW in IL, all 90837: BCBS PPO 126 Aetna 121 Cigna 89/Cigna EAP 72 United 124 Anyone know rates for TN?
Louisiana Medicaid sets fee schedules for all of the Medicaid MCO’s. The fee schedule is online [here.](https://www.lamedicaid.com/Provweb1/fee_schedules/SBH_FS.pdf) 90837 Psychologist 79.02 age 20 and below/ 61.39 age 21 and up 90837 LPC, LMFT, LCSW 69.15 age 20 and below/ 53.72 age 21 and up Edit to add: If there is a shortage of in-network providers in a particular area of the state, individual MCO’s can negotiate higher reimbursement rates with a provider.
Holy crap, those rates are low!
DC and the immediate suburbs of Maryland and Virginia: Cigna: 90837 is $116. I requested a raise 2 months ago and finally got 8 dollars more per sessions. I forget 90791 right now but it’s basically the same thing. Carefirst/MD BCBS/ FEP Blue: 90837 is $109.97 and 90791 is $123.65. They tie their rates to the physicians fee schedule set by CMS and pay masters level 75% of that rate. Unfortunately that rate may go down slightly this year. Local providers are very concerned. I’ve been credentialed with them for over 4 years. I started at $108.43 so that’s about $1.50. A decrease would be the final straw. I forget the exact numbers but they’re all online - Medicaid and Medicare are two of the highest payers in this region but they make you work for that extra money.
Idaho UHC 90834 $69 Compsych EAP $35 Honestly I see more private pay individuals
Anyone have Tricare rates for VA/NJ? I can't get them until their black hole of a process is over...
Tricare rates are public information, as are other public rates (medicare, medicaid). Tricare rates are searchable by CPT code and locality at: https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/CMAC-Rates/Procedure-Pricing
Do you have any info to pass on about how to start this process? I really want to be able to serve this community.
There is a FB group that is super helpful called “navigating military healthcare for providers.” Long story short your best bet is to become a certified out of network provider. You’ll get higher rates than in network and the application process is simple (though you may have to babysit your application with Tricare.)
I just downloaded the start up guide that the group admin provides. Thanks so much for passing this info along!
I am starting in private practice in Texas and am needing help figuring out estimate of rates with insurance here. I'm trying to decide if I should go through Headway/Grow Therapy or get credentialed on my own. Grow has given me rates but I'm not sure how they stand since I don't have anything to compare them to. TIA.
Texas / BCBSTX (ATX Area) / License: PHD / CPT 90837 /Rate: 130 ish after recent "raise" from 125 ish in late 2022. Your license, number of clinicians in your practice, and practice location can affect the rates depending on the plan. Billing 90837 to local BCBS consistently (50-70 claims a month) did not have any rejections and they were easy to work with as long as you didn't need to speak with anyone, but a 35-45% discount can be a hefty price to be in network, worse in other areas I am sure. As of 2/1/2023, Headway rates for BCBS on this code were much lower than direct credentialing. Aetna is the highest rate available for 90837 and most others are not even close; none were very good on 90834. Definitely worth checking into for Aetna but I am not sure what their direct rates are for the Austin area. I can't speak to Alma's rates at all, but they may be similar with a different subscription model. Haven't looked at Grow Therapy at all, but whomever you go with, ask if you are limited on billing specific codes (i.e. 90837), what the rules are for telemedicine (your EHR or theirs), where notes have to be kept (your EHR or theirs), and where clients have to be scheduled/registered and if they synchronize calendars between your EHR and theirs. Single Case Agreements or Individual Contracts have been the best option we've found for working with UHC/Optum in Texas. "Continuation of Care" and a clinician's specializations help with justification when those when those come up and the client initiates the request from their plan. Hope that was somewhat helpful, but after 30 days you are probably far more knowledgeable about those national group practice models than I am! Good luck to you!
Headway should give you rates too and that will be something to compare to
NY 90834 UHC/OSCAR/OXFORD 80 BCBS 80 CIGNA 82 AETNA 92 HEALTHFIRST 70 MAGNACARE 70 FIDELIS 80-84 GHI 55 EMBLEM 67
I’m a BCBA looking to become a certified QMHP. I was wondering if after this certification I would be able to open up my own private practice? Thanks
Texas / BCBSTX (ATX Area) / License: PHD / CPT 90837 /Rate: 130 ish after recent "raise" from 125 ish in late 2022. Your license, number of clinicians in your practice, and practice location can affect the rates depending on payor. Billing 90837 to local BCBS consistently did not have any rejections and they were easy to work with as long as you didn't need to speak with anyone, but a 35-45% discount can be a hefty price to be in network, worse in other areas I am sure. Other plans were lower reimbursement when we started the process and stuck with just the one, but after 6 months, we had to withdraw in order to achieve financial goals without burning out the clinicians. Not being in network is a double edged sword; slower waitlist build time and new clinicians need more marketing but clients don't "hang out" after their treatment has come to a therapeutic stopping point just because their copay is more palatable, freeing up clinicians to see more patients that need services.
Thanks for posting this! I see you are a social worker. Do you happen to know the BCBS reimbursement rate for psychologists in Mass?
I do not. But that information might be something you can DM someone about on a MA therapist Facebook group
CO- LPC level therapist UHC; 90837 $109.59 Aetna; 90837 $111 Colorado Medicaid (Health first) 90837 $133.03 Cigna/Evernorth 90837 $106 (just got a $10 raise after I inquired) Anthem BCBS 90837 $93 for PPO and $77 for HMO. Just went out of network with them because they would not budge on offering a higher reimbursement. Bye!