#237: Can Health Coaches Bill Insurance? (And Should You?)

Recently Lisa asked in our group, “Has anyone used a code to get a client’s insurance to cover coaching? If so, how would I acquire the correct code?” The answer isn’t exactly straightforward, so this week Michelle provides perspective on whether accepting insurance is for you or not. Get Michelle’s free training to grow your business at: HealthCoachPower.com/training

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Can Health Coaches Bill Insurance (and Should You?)

Health coaches are closer than ever to being able to bill insurance…but it’s a little tricky.

In this post, I’m going to share about where we stand with health coaching and insurance in 2023, where we’re headed…and some personal thoughts based on my 14 years in the industry.

What is a CPT code and why does it matter?

You know those little stickers they put on produce at the grocery store? The numbers on those stickers help streamline the checkout process. Everything is coded.

Well, CPT codes (short for “current procedural technology”) are similar – but for healthcare services.

CPT codes come in three categories:

  • Category I is for stuff insurance generally covers (think annual physicals or tests for strep throat).
  • Category II codes are for performance measures (not super relevant to us).
  • Category III codes are temporary codes created for “new and developing” procedures or technologies – and that’s where health coaching comes in.

CPT codes for health coaching

In January of 2020, the American Medical Association approved three Category III CPT codes for health and wellness coaches. That was major progress but it left a lot of coaches confused.

Does that mean health coaches can bill insurance or what??

Not quite.

As Category III codes, these new health and wellness coaching codes are generally NOT being reimbursed by insurance companies. At least not right now.

This means you can’t bill insurance and expect to get paid. Yet.

When will insurance cover health coaching?

The good news is, the path to insurance reimbursement for health coaching is being forged as we speak. Those Category III codes are a stepping stone.

They can help to track when health coaching services are used in healthcare settings and how much value they provide. This is the kind of data that can help convince companies that we’re worth it.

Eventually (hopefully) the coaching CPT codes will move out of Category III and insurance companies will start to reimburse for them.

But no one knows when that will happen, or if it will necessarily happen at all.

How health coaches can bill insurance (when it’s time)

When that day comes, health coaches who want to bill insurance need to be prepared. Insurance companies are sticklers!

You’ll need to be certified by the NBHWC– if you’ve graduated from an approved program, you can submit documentation of coaching hours completed and take a test to earn this credential.

You’ll also need a National Provider Identifier (NPI).

What Is an NPI Number and do health coaches need one?

An NPI number is a unique identifier for healthcare professionals – kind of like a professional social security number. Insurance companies use NPI numbers to know who’s providing services.

If you want to hit the ground running, you can go ahead and get an NPI number now– they don’t expire. And you can apply for one for free (do it online here).

The pitfalls of working with insurance

I’ve talked to a lot of healthcare providers – and overwhelmingly, they’re beyond frustrated with the insurance system.

Paperwork. Admin time. Back-to-back patients all day. Getting stuck with whatever the insurance company decides to pay you. This is the reality for a lot of people working in insurance-based healthcare – along with major burnout.

Plenty of highly educated folks – doctors and nurses included– decide to leave their jobs because it’s just not sustainable. I’ve known several who’ve gone on to become health coaches because they value getting to call their own shots and spend more time with clients.

See, as health coaches running our own practices, we can decide what to charge and how to run our businesses. And that doesn’t have to include insurance if it doesn’t work for us.

Does accepting insurance increase access to health coaching?

You might think that accepting insurance would make health coaching available to more people– but I’m not so sure.

In my practice, I charge enough that I don’t have to book myself solid with clients all day long. This allows me to create resources that are available to anyone and everyone – and to offer scholarships and sliding-scale payment options.

I get to be the kind of health coach I want to be, and live the kind of life I want to live. I’m not burning out.  And I can help people who need it, including some who can’t pay my regular fees.

But if I were forced into an insurance model?

I might burn out trying to keep up with related admin tasks and simultaneously meeting with as many clients as humanly possible all day long, to make up for insurance’s lower payouts.

How clients can use pre-tax income for health coaching

As we wait to see what unfolds with the health coaching CPT codes, some clients may still be able to use some of their benefits to pay for health coaching through a Health Savings Account (HSA) or Flexible Spending Account (FSA).

These accounts let people use pretax income for health-related expenses. Some companies (but not all) put health coaching in this category.

Clients who want to use HSA or FSA money to pay for your services might need an invoice with specific language included – the exact requirements vary depending on the company. And sometimes they even have a specific card they can pay with directly.

One of the great things about this system is that it’s client-driven. They do the legwork to understand their own benefits, and you do the health coaching. You can charge what you want to charge. And your client gets to use their benefits. That’s a win-win.

Don’t wait for insurance– grow your health coaching practice now

We don’t need to wait for the health insurance industry to catch up – we can offer services to clients now. And as health coaches in private practice, we can choose what to charge and how many clients to see.

The point is…

Your business can thrive whether you plan to accept insurance in the future or not. And I can help! Sign up for my free training where I’ll show you how to earn a living doing the work you love.


Full transcript:

Hello there health coaches! Have you ever wondered about taking insurance? This comes up again and again and again. Today we're going to talk about it, what the idea of health coaches being able to build insurance is more of a reality today than it's ever been before. And I want to explain where we're at in 2023, where we're likely headed as an industry and whether or not it's a good thing. So tell me in the comments, if you are here live, tell me, would you like to be able to accept insurance and what's your experience been with insurance so far? People... Are your clients asking you for it? Have you looked into this already? Just curious where everybody is at now, if you are in private practice and you're looking to add clients to your business, there are plenty of people out there who can afford your services.

I just want to say that right up front, out of pocket, full price. I know because I have 13 years of experience as a practicing health coach, and if you want to know how I did it, by the way, there is a free training that is waiting for you at healthcoachpower.com/training. Inside that training, I will show you exactly how to earn a living doing the work that you love, regardless of whether you can bill insurance for it or not. So I'm just going to drop that link here. Again, it is healthcoachpower.com/training.

Now, some coaches, some of you out there might be familiar with medical billing and insurance models. Yes, anybody, most of us, including myself, have never worked in that realm. So, I'm here for you guys. I'm not going to talk over your heads today. This is stuff that I'm learning as we go just like everybody else.

I know though, as a practicing health coach, I have definitely had clients who say like, Hey, do you accept insurance? It's one of their questions during the consultation, and I'm wondering if that's ever happened for you. I see Kim's here and oh gosh, a whole bunch of you. Sometimes I don't know what your Instagram names mean or I can't read them or I don't know what your first name is, but plant power. Oh, Paige is here and Kaylesia is here. Anyway, have you guys ever had someone ask, do you accept insurance? I want to give you the scoop about how to work with what the system currently provides while also making the best decision for you and your business. So there is something called CPT Codes. Ever heard of 'em? I really haven't before all this started erupting in the health coach world.

So it's kind of like the number on each type of produce at the grocery store, that little sticker. And if it starts with a nine, that means that it's organic. So by having that number on the apple or on the zucchini or whatever, it just streamlines the checkout process because cashier just types in the number. Except if you're like me and the cashier is like, is this spinach? And I'm like, no, those are dandelion greens. Is this a potato? No, that's raise a hand if you're always educating the cashiers. Anyway, CPT codes are not for produce at the grocery store. They are for medical and healthcare services performed by doctors and other healthcare professionals like us. And they come in three categories, category one, two, and three. Kim is saying insurance is challenging, insurance is challenging on both sides of the equation as the individual who's going to the doctor or the dentist or whatever.

We've all dealt with insurance. Now we're talking about dealing it with it from the other side. So three categories of those CPT codes, categories one, two, and three. If something is category one, you're the insurance company, Aetna, United, whatever, they're going to cover it like an annual physical or a strep throat test. Okay? Categories two and three, not so much like the codes exist, but that doesn't mean the insurance company is like, yeah, sure, here you go. Here's your payment for that. So back in January of 2020, the American Medical Association approved. This was a very, very big deal at the time. They approved three category three CPT codes for health and wellness coaches category three. So that means that the codes exist for us. Insurance companies, they're not paying squat, at least not right now. So the short answer is no health coaches cannot bill insurance, at least not if you want to get paid as of today in 2023. I mean you can bill 'em all day long. That doesn't mean anything's going to happen. You're not going to actually get paid for your work.

So that's a short answer, but the longer answer is that down the line, and this is the exciting part down the line, the path is now forged for health coaches to be able to bill insurance someday if we can get out of category three. Now, when is that going to happen? Someday? When is someday? Nobody knows. That's where we're at now when that day comes, and I'm thinking to myself, we got these codes in 2020, so now we're in 2023. How many more years is going to be when it comes? If you want to bill insurance, you're going to have to be certified by the NBHWC. That's the National Board of Health and Wellness Coaches, and you'll need a national provider identifier or an N P I number, and you can get that now, which I found interesting. So if you wanted to get ahead of the curve, it's not like it expires or anything, you can actually go and get your NPI number now, and presumably you could hit the ground running as soon as we get our category one CPT code.

Kind of a complicated answer. So it's even more complicated. I started to really think about it for the past couple years. I'm like, wow, this is really exciting. This is pretty cool. This is definitely growth for the health coach industry. And I mean, it is wild to see our industry grow and change and evolve over the 14 years that I've been involved and as a certified health coach myself. But when I think about this topic, like Kim was saying earlier, insurance is challenging. That's such a kind way of putting it from what I've heard, from what I've seen. One of the worst parts of working in healthcare. And if any of you work in healthcare now, maybe you can chime in with your thoughts. The worst part of working in healthcare is having to deal with insurance. I never really thought about it too much from the side of the practitioner until several years ago now, gosh, how many?

Five, six years ago, I don't even know. I went through Dr. Aviva rom's professional training program where I met a lot of nurses and doctors and other licensed medical professionals, and they all wanted to practice in a more holistic sense, all interested in functional and integrative medicine. That's why we were all there together. And as I got to know these other practitioners wildly, the overwhelming sentiment was, I wish I was a health coach. Oh, you are so lucky. These are MDs saying this. And I was like, whoa, whoa, what? Just shocking because health coaches, we always assume we're not skilled enough. We're not taken seriously enough. Nobody wants to be us. We wish we had the letters after our name. Meanwhile, these doctors, these nurses were wishing they could be like us. Who knew? Who knew, and guess why? Just take a wild guess why they might wish for the life of a health coach insurance. That's what it kept boiling down to. For them, insurance means paperwork. Insurance means admin time. Insurance means you get what the insurance company decides to pay out for a given service. Insurance means people are used to giving their $20 copay and then they block at any higher end services.

As I started to hear these things, I was like, that's very interesting perspective. Meanwhile, as a health coach, we're able to skip all of that stuff. We're able to charge whatever we want. No wonder these folks who have been through years and years, more education and of all the letters after their name, et cetera, and have way more oomph in the medical world, they wish they could be like me. So think about it. I'm sure most of us, myself included, we've all been to some doctor, some specialist, some practitioner. Have you noticed that usually the very, very best doctors don't take insurance ever noticed that even though they could, I mean they have the codes, they have the right to bill insurance, whatever. They have the ability to do that. They don't. They choose not to because insurance is pain in the neck and you get paid less.

And the very best doctors, they want to be able to spend more time with their patients. They want to run their practice the way they want to run their practice. And because they are in demand, because they are good, they know they can fill their practice out of pocket patients instead. And they do. Yeah. Have you ever paid out of pocket to go to a practitioner? 1000%. I know that for many health coaches and for all types of practitioners, we want to be able to serve the masses. So, it kind of feels icky to be like, well, I'm only going to work with people who can afford exorbitant fees. We want to be able to help people who can't afford thousands and thousands of dollars out of pocket. Yes. But I imagine, and you should probably consider how taking insurance as a health coach is going to increase your admin time considerably.

It's going to put a ceiling on your earnings. And with most insurance covered practitioners, they have to see a lot of patients, or in our case clients every day, they're back to back all day long, 15 minute appointments, 10 minute appointments, bang, bang, bang, bang, bang, get 'em in so that they can get paid by the insurance for each one so that hopefully by the end of the day it adds up to enough. So with less time spent with each client meetings booked back to back, yikes. That is not the kind of health coach I ever wanted to be. Starting to sound kind of grim. That's how I was processing it in my head. So I don't know how you feel, and I love your thoughts on this. There are a lot of different healthcare practices out there, right? There are functional medicine doctor's offices, there are holistic health centers.

Depending on your practice, maybe this insurance model might make sense for you. Yes. No. Tell me in the comments how it's landing for you now as we kind of talk about the pros and the cons of health coaches being able to accept insurance from where I sit, and again, I've been in private practice as a health coach, had many, many years experience. I'd rather skip it. I'd rather work with clients who can pay out of pocket and be able to offer scholarships, be able to offer sliding scale options to clients who can't afford it. I'd rather work on my own terms and set my own hours and keep my client load manageable so I can avoid burning out and keep being effective and happy at work for many, many years. And we know that those in healthcare are not, they're burnt. Many times they're, they're sick of their jobs. I know. Cause so many of them quit and become health coaches and then they're talking to me, oh, I used to be a respiratory therapist. Oh, I used to be an occupational therapist. Oh, I was this, that, and the other thing. I want to be a health coach now.

So, is insurance something that we should be wondering about? Yes, of course it's going to make things change in our industry for sure. But should we be waiting for it? Like, oh, once I can take insurance then then it's going to be something pursuing my clients is going to be worthwhile. No, no, don't wait. And I don't think we need to feel bad that we can't accept someone's insurance card right now. My perspective is that we're lucky. We're very, very lucky to not have to deal with any of that. The precedent in our industry is not set that it's a $20 copay. We have no limit to how we can structure our services and what we can charge for them. So in the meantime, as we wait to see what unfolds with this whole CPT code thing, there is one way that client can use one aspect of their insurance.

I'm not sure if you know about this. We do get a lot of questions, so I want to address it now. We're still going to have to find our own clients regardless of whether clients are using their insurance or not. Until a day far from now, no one is finding us through their insurance website, right? No one is being told they have to go see a health coach. So this just brings me back to the free training that I mentioned earlier. If you want to be able to earn a living as a health coach, I'll show you how it's all at healthcoachpower.com/training. That's my free training. And here's how insurance can be a little bit useful to you in your clients right now. I've had several clients through the years actually get reimbursed. Get reimbursed rather through their HSA or their FSA, the flex spend accounts.

Now, it's not a given. I learned this the hard way. Not every HSA or FSA seems to accept health coaching as an allowable expense, but many of them do. So I've had to give clients an invoice may, maybe it has to have a very particular term on it. Maybe I have to give certain information, whatever their company wants in order for them to get the reimbursement. But it's happened. I've had clients be able to with their pre-tax dollars for our work together, which is pretty awesome and a great incentive if your clients have a flex spend account available to them. Now, sometimes clients will have a card, which I've somehow, I've just never personally been in that situation where I accepted an F s FSA card, but I have heard from coaches who've done this. So that is a possibility that you can just run their card the way that you would run any credit card, and then again, it would be paid for out of their flex spend account.

But what I really love about this option, it puts the responsibility on the client. They're going to go find out what their flex spend plan will cover. That's not your admin time. They're going to figure out how to make that happen. And then as a health coach, you still get paid your full fee. It's not like the insurance company is dictating how much you're charging and it takes a couple of minutes to draft up an invoice if that's what you have to do. At the end of the day, the client gets their reimbursement, they're happy, you are happy. It's like a win-win. So I do like this aspect of including someone's insurance, but only only in this sort of FlexPen manner. Here is my suggestion overall, there's so much of this. Instead of comparing and despairing thinking, oh, I'm just a health coach. Oh, I wish I had more credentials.

Oh, I wish this, I wish that. Let's just realize how great we have it, you guys. If doctors want to be like us, because we can actually take the time to really help people meet with our clients for an hour, especially when people have chronic conditions, we know the medical system is failing them. So I say, let the medical establishment handle the emergencies, handle the broken bones. Great insurance is great for that. They do a great job with that, and we can just focus on helping the other millions and millions and millions of people on earth feel better. How's that sound? I'll see you all soon. Thanks for being here.