Can LMSWs provide statements for insurance reimbursement?
Patients with out-of-network (OON) insurance benefits for behavioral health services can claim reimbursement for psychotherapy and psychoanalysis services, regardless of whether their clinician is licensed to see patients unsupervised, or if their clinician requires supervision to see patients.
I do not receive or accept payment from insurance companies; my financial arrangements are between me and my patients.
Those of my patients with OON benefits claim reimbursement by submitting a CMS-1500 form, downloadable here, on which they fill in the top half, write “See attached” across the bottom half, and attach the statement I provide them (see below).
My statements include the following information:
– Patient’s name
– Dates of service
– Fees per session and total (my statements also show beginning balance, payments received, and ending balance, but these are not necessary for insurance reimbursement purposes)
– Service rendered CPT code (90834 is the CPT code for a 45-minute psychotherapy session; 90845 is the CPT code for psychoanalysis)
– ICD-10 diagnostic code (these can be found all over the place)
– My name, phone number, and license number and expiration date. (Unlicensed providers would omit their license information.)
– While I was required by the state to practice under supervision, I provided my supervisor’s name, licensure, license number and expiration date. Now that I have my “LCSW,” I omit this information. You can ask your supervisor for this information, or you can look it up on this web page, if s/he’s licensed in NYS.
– The taxpayer identification number (TIN) and national provider identification (NPI) number for the entity providing treatment.
– For patients in my private practice, I use my own TIN (my social security number, until I complete the formation of my PLLC) and my NPI number.
– If you don’t have an NPI number, you can get one, instantly, and free (as I recall), on this page.
– A note saying, “Insurer: Please remit all payments to patient.” This is so insurers don’t send me checks. Some clinicians allow patients’ insurers to pay. If this is your practice, you would omit this line.
I got my supervisors’ permission to issue such statements at the beginning of their supervision of me. As you can see, there’s nothing on this statement that is in any way controversial, or that makes any representations or claims. It is simply a recitation of facts. None of my supervisors ever objected to my issuing such statements monthly, and my issuance of the statements never came up again in supervision. I can’t imagine a supervisor denying permission to provide patients with such a statement.
