We were surprised and gratified by readers’ response to the information about using a superbill in our August 2007 column and have received almost 100 requests to date for examples of our superbill.
With the superbill option, the counselor can collect the fee at the time of the session. The client then sends the superbill directly to his/her managed care or insurance company to be reimbursed. Many insurance companies accept the superbill for reimbursement, but some may not.
Q: I have a question about a certain managed care company. I recently got on their panel, but they keep referring EAP clients to me. I don’t really understand the difference between an EAP client and a regular counseling client, other than the fact that I don’t get paid nearly as much to see the EAP clients. Is this sort of a scam, or is there something I don’t understand about this system? How can I get paid the full counseling fee for seeing these clients?
A: First, let’s start by defining terms. EAP stands for employee assistance program. Most major employers offer EAPs as a benefit to employees and their families. EAP is essentially a counseling assessment and referral service paid for by the employer. Employees can confidentially access counseling services (or be referred by the employer) for mental health, marriage/family, substance abuse, elder care, legal or financial issues at no cost to the employee.
In the past few years, managed care companies began offering EAP services bundled in with the insurance package. Most of these bundled packages offer a few “no cost” sessions for the insured, meaning they do not have a copay or fees applied to their deductible. The insured can see any counselor, not just the EAP counselor, and be covered by the managed care company to use the EAP benefit. Typically, EAP session reimbursements are at a slightly lower fee than the regular insurance contract rate. However, after the EAP sessions, and if clinically appropriate, the counselor can continue treating the client and access the regular insurance benefit.
We don’t recommend signing up with a couple of managed care companies due to their horrible EAP rates (their regular fees are not much better) and the extensive paperwork involved. Contracts for getting on managed care panels can include participation in both the EAP and regular insurance program. Read the contract before you sign it. You can choose not to participate in the EAP and still be a provider. If you decide not to accept EAP clients, look at your contract and see how to terminate participation. Don’t, however, just refuse to accept EAP clients, because you have a signed agreement, and they could come back and hold you to the letter of the law.
Q: I am a therapist in private practice. What is the appropriate time frame for sending a termination letter to a client who has dropped out of therapy but has not officially notified the therapist that they do not wish to continue?
A: We don’t know of any standard procedure that addresses what to do should a client “drop out” of therapy. The 2005 ACA Code of Ethics addresses termination and referral issues in Standard A.11. However, there is no exact reference either to method of contact or time frame should a client discontinue therapy without notifying the counselor.
Still, while there are no hard and fast rules, there are other considerations. In the Health Insurance Portability and Accountability Act documentation (or in the informed consent document), clients should have indicated how they wish to be contacted. If they did not give you permission to contact them at home, then no letter can be sent.
If clients have granted you permission to contact them at home, then a phone call or letter advising them of the missed or canceled appointment and inquiring if they wish to reschedule would be appropriate. If, in your clinical judgment, the client needs ongoing counseling or you think a referral to another professional is appropriate, then you can send a certified letter outlining your concerns (again, if HIPAA compliant).
We will be presenting our workshop “Starting, Maintaining and Expanding a Successful Private Practice” on Dec. 1 in Illinois. The Illinois Mental Health Counselors Association is sponsoring the workshop. For more information, contact IMHCA at 800.493.4424 or visit www.imhca.org/.
Robert J. Walsh and Norman C. Dasenbrook are coauthors of The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counseling-privatepractice.com). ACA members can e-mail their questions to walshgasp@aol.com and access a series of “Private Practice Pointers” on the ACA website at www.counseling.org.
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