Why Denied Claims Are So Common in Behavioral Health
Why Denied Claims Are So Common in Behavioral Health
Claim denials are a frustrating part of running any healthcare practice but behavioral health providers face this problem more than the most. While all providers deal with insurance challenges, behavioral health billing comes with its own set of hurdles.
1. Behavioral Health Has Unique Billing Rules
Unlike physical health services, behavioral health has extra billing rules. For example, therapy sessions often involve time-based CPT codes (like 90837 for 60-minute sessions). If you bill for a full hour but only see the patient for 50 minutes, that can lead to a denial.
Also, different insurance payers have different rules for what’s covered. One insurer might accept a certain therapy code, while another rejects it. Without careful payer-specific knowledge, it’s easy to get it wrong.
2. Authorization Requirements Are Confusing
Many behavioral health services require prior authorization, even for routine therapy sessions. If the provider skips this step or uses the wrong authorization number, the claim will be denied. What’s worse, behavioral health authorizations often expire quickly or cover only a limited number of sessions. Keeping track of all this manually is hard, especially in busy practices.
3. Documentation Doesn’t Match the Claim
In behavioral health, what’s written in the notes matters just as much as what’s on the claim form. If the documentation doesn’t support the billed service, for example, if there’s no mention of a specific diagnosis or treatment method, insurance companies will reject the claim.
Behavioral health also deals with subjective conditions like depression, anxiety, or trauma, which can be harder to quantify. If the documentation doesn’t clearly show “medical necessity,” the claim may be denied, even if the service was completely appropriate.
4. Lack of Coding Expertise
Many behavioral health providers try to handle billing in-house, but mental health coding is not as straightforward as it seems. For example, using the wrong modifier (like billing a telehealth session without the correct modifier such as 95 or GT) can instantly lead to denials.
Because coding rules often change, staying current without dedicated billing support is a constant challenge.
5. Insurance Companies Apply More Scrutiny
Unfortunately, mental health services are often subject to tighter review processes. Payers might ask for extra paperwork, apply stricter rules, or even deny claims for services they would approve in a medical setting. This puts behavioral health providers at a disadvantage, even when they’re doing everything right.
How Instapay Healthcare Services Can Help
At Instapay, we specialize in behavioral health billing. We know the common traps, and we’ve built systems to prevent them. From pre-authorizations to claim submission and follow-up, our team ensures your practice gets paid faster, and with fewer denials.
We also keep your documentation in sync with payer rules, provide regular claim audits, and stay on top of evolving insurance guidelines.
Final Thoughts
Denied claims slow down the cash flow and increase stress for behavioral health providers. But most denials are preventable with the right knowledge and support. At Instapay Healthcare Services, we’re here to take that burden off your plate so you can focus on what really matters: your client’s well being. From patient eligibility to billing and coding of claims to payment posting and finally the follow-ups with insurance companies for reimbursements, Instapay Healthcare Services does it all
Want to reduce denials and get paid faster? Contact Instapay Healthcare Services today to learn how we can support your behavioral health practice.
