LMSWs and insurance reimbursement

I’ve had a couple of conversations with people recently who are under the mis-impression that either because they are not on insurance panels, or because they do not yet have their LP or LCSW, their patients cannot receive out-of-network benefits reimbursing them for some or all of the costs of therapy they provide.

Given the conversations I’ve had in the last couple of weeks, I thought some people in this group might appreciate seeing the facts as I understand them, based on my recent experience, all laid out in one place.

The bottom line: I’m aware of no reason patients whose insurance provides some reimbursement for out-of-network behavioral health costs cannot receive such benefits in connection with any therapy provided by any provider, so long as that provider either a) is licensed to provide therapy without supervision, or b) is permitted to provide therapy under supervision. From the very first day I was practicing as an LMSW, I’ve had patients successfully submit statements provided by me for reimbursement to their insurers, and they’ve received thousands of dollars in benefits.

There’s a lot of confusion about these questions, confusion muddled by imprecision of language. I’ve often heard “LMSWs cannot submit for insurance reimbursement,” or some variant of that – often referencing the law (it’s “illegal” or “prohibited,” I’ve heard). I think it’s really important to be clear: patients can submit statements showing treatments provided by LMSWs, and supervised by licensed clinicians, for reimbursement. I make no claim larger than that here.

Here’s some more words laying out my experience and understanding in greater detail. If you have questions, please ask.

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1. When I was a social work intern (not yet an LMSW), I provided psychotherapy in a clinic operated by an analytic institute that was “in-network” with a number of insurers. The institute received in-network benefits for several of the treatments I provided under supervision, and out-of-network benefits for at least one.
2. When I was an LMSW, I provided psychotherapy in two venues – one, a clinic operated by my analytic institute, and one, a group practice. In each venue, patients of mine received out-of-network (but not in-network) reimbursement for services provided by me, under supervision.

I’ve heard lots of people say variations of “LMSWs can’t submit for insurance benefits.” This is, surely, correct, as LMSWs cannot be paid by patients/clients for psychotherapy – only the entities under whose auspices they practice can.

And/but: There are, to my mind, two questions, one of whose answer I know, and one I believe I can guess:

1. Can an LCSW who is on an insurance panel bill that insurer for services rendered by an LMSW under her/his supervision?

I’m not sure, but I’d bet the answer is “yes.” (See what I wrote above, about the clinic operated by the institute where I interned.)

2. Can a patient, treated by an LMSW under supervision by an LCSW (or another suitably licensed clinician) submit her/his statements for out-of-network reimbursement by an insurer?

The answer to this question is, definitively, “yes.” And I would make several ancillary points:

1. This is a question about what a patient may do with the statements we issue – see below, c) – not about what a clinician may do. We don’t exercise control over what our patients do.
2. Implicitly, it’s a question about how insurers may respond, and I can state, definitively, based on relatively recent experience, that (at least some – and all of which I’m aware) insurers treat such submissions exactly as they treat submissions for services rendered by out-of-network LCSWs.
3. Over my nearly four years as an LMSW, I encountered a lot of confusion about this question. There are four distinct actions implicated here:
   1. Provision of psychotherapy: this is done, in this instance, by an LMSW, under supervision by a qualified, licensed clinician.
   2. Issuance of a “statement,” suitable for submission by a patient to her/his insurer. This is, essentially, a superbill. When I was an LMSW, my patients received statements that showed: their name, dates of service, fee charged, payments received, CPT code for service rendered, ICD code for diagnosis, names and license numbers of BOTH me and my supervisor, and TIN and NPI of the entity through which I was providing service. THIS WAS A FACTUAL, INDISPUTABLE STATEMENT. I didn’t need anyone’s permission – other than my supervisor’s, and that of the entity under whose auspices I was providing service – to issue it. Such a statement is just a recitation of facts. And a reminder: I believe that NYS’s view is that my patients were receiving treatment by my supervisor. For this reason, the statement I provided “my” patients needed to be approved both by my supervisor and by that entity.
4. The submission by a patient/client of such a statement together with a claim form. Clinicians – and patients – often think they must “fill in” a CMS-1500. This is simply incorrect. I say this both as a patient and a clinician. The patient need only fill in the top section of the form, and submit it with “see attached” scrawled across the bottom section of the form calling for the clinician’s input: every insurer processes such forms. So… a patient submits a claim form, together with the statement I’ve provided (a Superbill, for those who use software), and the insurer processes it.
5. The processing by the insurer and acceptance or rejection of a claim. This is, surely, completely out of our hands. But my experience as an LMSW was that no insurer rejected a claim for reasons having to do with an LMSW being listed on the attached statement.

A final note: my understanding is that, in New York, although an LMSW may be the clinician meeting with the patient, the “rendering provider,” actually, is the supervisor. I was asked recently how I thought the CMS-1500 should be filled in with respect to the “rendering provider” in box 31. My instinct is that, for the reason I just cited, the rendering provider is the LCSW (or supervisor). I don’t know this, as I’ve never filled in such a form, except as a patient (when I’ve always scrawled, “See attached.”). But that’s my gut.