Third party payment law in Connecticut, also referred to as Vendorship, requires health insurers to reimburse eligible social workers for diagnosis and treatment for mental or nervous conditions, when the policy comes under the state law. Generally speaking reimbursement is restricted to licensed clinical social workers, however non-licensed MSW’s may be eligible to bill insurance in certain settings (described below).
ELIGIBLE SOCIAL WORKERS BY STATE STATUTE:
- Licensed clinical social workers (LCSW) who have passed the clinical examination of the Association of Social Work Boards and have completed at least 2000 hours of post-master’s social work experience in: a non-profit agency qualifying as a tax-exempt organization under Section 501 (c) of the Internal Revenue Code of 1986 or any other subsequent corresponding internal revenue code of the United States; in a municipal, state or federal agency; or in an institution licensed by the Department of Health Services. At this time practically all insurers simply seek the LCSW regardless of whether the above noted 2000 hours have been met or not.
- Licensed clinical social workers that were certified by the State of Connecticut as a Certified Independent Social Worker (CISW) prior to October 1, 1990 (the 2000 hours and examination requirements in #1 do not apply to this group).
- A MSW providing services in a child guidance clinic under the supervision of a psychiatrist, physician, licensed psychologist, or licensed clinical social worker.
- A MSW providing outpatient services in a non-profit community mental health center as defined by the department of mental health or in a non-profit licensed adult psychiatric clinic operated by an accredited hospital, under the supervision of a psychiatrist, licensed psychologist, or licensed clinical social worker.
INSURANCE POLICIES THAT COME UNDER THE LAW AND EXCEPTIONS
All group and individual health insurance policies written in Connecticut come under the third party payment statute. However, individual policies (those covering an individual vs. an individual who is part of a group policy) may not have mental health benefits included. Additionally, the following EXCEPTIONS exist that exempt at least 50% of all policies.
- If the group policy is through an employer that is self-insured than the policy is exempt from state insurance mandates including social work vendorship. It is important to note that the employer may contract with an insurance company to administer their policy, so the key here is to determine who is the employer. Many large employers and even some mid-size employers are self-insuring. This does not mean that they will not accept social workers as providers; it means they do not have to accept social workers.
- Group policies written out-of-state where less than 50% of the employees on the policy are in Connecticut.
- Individual policies written out-of-state.
Managed care organizations can deny access to their provider panels even if you are eligible under the vendorship law. Individual’s seeking to become a provider for any given managed care panel must contact the provider relations unit of the managed care company to apply for provider status. In some cases managed care organizations may authorize the individual provider for specific patients but not accept the provider on their panel.