The Insurance Paradox: Why Smart Therapists Disagree About the Same Decision

It depends is what I'm hearing after speaking with Behavioral Health professionals on the insurance paradox. After interviewing a financial planner it depends on:

• US location and zip code given insurance is at risk model with patient population.

• Where you're at in Mental Behavioral health profession; just getting started, middle part or been treating patients for 15+ years in various clinical settings.
• Medical Liability plays a role on which payer model you practice under meaning a health system, value-based care, FQHC, community or county health programs, large practice with integrative health with multiple locations, accepted mix insurance plans commercial, medicare, medicaid or self-pay.
• What is the business cost? After evaluating claims and reimbursement trends for the past year or two for mental and behavioral health services unlike the physical medicine, mental health service claims typically get denied more and limit on prior authorization and appeals.

The current trend in behavioral health is take on added revenue along with the payer mix in the insurance paradox are: buy and bill medications for resistant cases, Telehealth or TelePsychiatry for access to services and remote therapeutic monitoring that extends the patient interaction between sessions for better outcomes and reduce hospitalizations. So it depends.

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