Should Health Coaches Bill Insurance? What Doctors Know That You Don’t

Michelle Leotta: Welcome to the Health Coach Power Community Podcast. I'm Michelle Leotta, ex-corporate girl turned certified health coach with over 15 years of experience growing a successful online practice. I started out with no idea what I was getting into and learned a lot of lessons along the way that have given me the freedom to do the work I love and raised two boys as a single mom.

I created a Health Coach Power Community over a decade ago to make it easier for health coaches to build a career they love and make the world a better place.

Hello there, health coaches. Before we jump into today's episode, I wanna give you a quick update because the world of insurance and health coaching is shifting since I originally recorded this episode. Medicare has started exploring a proposal, and from what I've read, they're looking to move our provisional CPT codes into permanent codes.

Cool. So this feels like a step forward. These codes would now be valued on par with chronic care management codes, so that means consistent nationwide rules, a clear payment structure, plus general supervision would apply. So that means health coaches could deliver services without a doctor being physically present, as long as there's real-time communication available.

Again, at least that's how I understand things. It is a little complicated. And all that said, this is still just a proposal, but it's new, so I wanted to let you know about it. It also comes with fine print, like working only with clients who have two or more chronic conditions, documenting measurable outcomes.

And you would need to be certified by an approved organization like the N-B-H-W-C. So is this the forward movement we've been waiting for, or what? Maybe. But the same big questions are still hanging out there, like, is billing insurance the right move for you and your business? Is it gonna help you serve more clients, or is it gonna bury you in a pile of admin work?

That's what this episode is all about. So let's rewind to the original recording where I break down the landscape. This was back in 2023, but plenty of insights that still very much apply today. Here we go.

Hello there, health coaches. Have you ever wondered about taking insurance? This comes up again and again and again.

Today we're gonna talk about it. You know 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 wanna 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?

Are people, are 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 wanna say that right up front, you know, out of pocket, full price.

I know because I have 13 years of experience as a practicing health coach, and if you wanna know how I did it, by the way, there is a free training that is waiting for you at HealthCoachPower.com/Training, and 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 gonna drop that link here. Again, it's 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 gonna 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. I 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. What Plant power. Oh, Paige is here, and Mia is here. Anyway. Have you guys ever had someone ask, do you accept insurance? I wanna give you the scoop about how to work with what the system currently provides.

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. You know, that little sticker. And if it starts with a nine, that means that it's organic, right?

So by having that number on the apple or on the zucchini or whatever, it just streamlines the checkout process because the 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 jicama.

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 health care services performed by doctors and other healthcare professionals like us. Yeah, 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. You know, like as the individual who's going to the doctor or the dentist or whatever, you know, we've all dealt with insurance. Now, we're talking about dealing with it from the other side. So, three categories of those CPT codes: categories one, two, and three.

If something is category one. The insurance company, Aetna, United, whatever, they're gonna 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 wanna get paid. As of today in 2023, I mean, you can bill 'em all day long. That doesn't mean anything's gonna happen. You're not gonna actually get paid for your work. So that's the short answer. But the longer answer is that down the line, and this is the exciting part, down the line, the path you know, is now forged for health coaches to be able to bill insurance someday.

Like, if we can get out of category three now, when is that gonna 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 gonna be. When it comes, if you wanna bill insurance, you are gonna have to be certified by the N-B-H-W-C.

That's the National Board of Health and Wellness Coaches, and you'll need a National Provider Identifier or an NPI number, and you can get that now. Which I found interesting. So if you wanted to get ahead of the curve, not like it expires or anything, you can actually go and get your MPI number now, and presumably you could hit the ground running as soon as we get our category.

Ah, kind of a complicated answer, right? So, it's even more complicated. I started to really think about it, you know, over 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 you know, 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.

Ugh. 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 Romm's professional training program, where I met a lot of nurses, 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 gotta know, these other practitioners. Wildly I, 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, right? Meanwhile, these doctors, these nurses were wishing they.

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 balk at any higher-end services. Yeah. You know, like 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 administrative 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 doctors, 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 a pain in the neck, and you get paid less.

And the very best doctors, they wanna be able to spend more time with their patients. They wanna run their practice the way they wanna run their practice. And because they are in demand, 'cause they're 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 gonna work with people who can afford exorbitant fees. We wanna 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 gonna put a ceiling on your earnings, and with most insurance-covered practitioners, like 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, like that's how I was processing it in my head. So I dunno 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 doctors' 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 as we kind of talk about the pros and the cons of health coaches being able to accept insurance. You know, 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, 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 sick of their jobs. I know, 'cause so many of them like 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 wanna be a health coach now. Right. So is insurance something that we should be wondering about?

Yes, of course. It's gonna make things change in our industry for sure. But should we be waiting for it? Like, oh, once I can take insurance, then you know, then it's gonna be something. You know, pursuing my clients is gonna 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. Like, 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. Right? 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 wanna address it now. We're still gonna have to find our own clients. Regardless of whether clients are using their insurance or not. Like, 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 and your clients right now.

I've had several clients through the years actually get reimbursed rather through their HSA or their FSA, you know, the flex spend accounts. Now, it's not a given, not every, 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.

Maybe it has to have a very particular term on it. Maybe I have to give certain information, you know, whatever their company wants, in order for them to get the reimbursement. But it's happened. I've had clients be able to pay with their pre-tax dollars for our work together, which is pretty awesome and a great incentive if fewer clients have a flex spend account available to them.

Now, sometimes clients will have a card. Somehow, I've just never personally been in that situation where I accepted an 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 is that it puts the responsibility on the client. They're gonna go find out what their flex spend plan will cover. That's not your admin time. They're gonna 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.

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 the 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, but only in this sort of flex pen 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, doctors wanna 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 said, 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.

So, even though I recorded this episode a while ago, so much of what I shared then still holds true now. Yes, the industry is making small moves forward, and yes, the idea of health coaches billing insurance is getting closer to reality, but you don't have to sit there and wait for policy changes, and you don't have to wait to start helping people.

You can build a thriving practice. You've got options right now, and you have more freedom than most health practitioners to build a business on your own terms. Now, if you're wondering how to do that, check out my free blueprint. It's at HealthCoachPower.com/Training. I'll show you exactly how to add more clients to your practice.

Thanks for listening. Keep doing good work, insurance or no insurance. Your impact starts now.

Thank you so much for listening to the Health Coach Power Community Podcast. Please take a moment, leave a written review on Apple Podcasts. It helps us reach more coaches and allows me to bring you this free content every week to join us live. Ask your questions and have a direct line to me. Join our free Facebook group at HealthCoachPowerCommunity.com.