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11/15/2023
Critical Alert: Highmark Policy Clarified
PCA Leadership has received a number of inquiries regarding concerns about Highmark’s policies related to permissibility of billing by pre-licensed counselors under supervision. We have reviewed the documentation sent from Highmark, which generated more questions than answers. Recently, we discussed this issue directly with Highmark’s leadership, who has communicated that their legal team deemed it illegal to issue payment to a provider that is not licensed, referencing a pre-existing PA insurance law.
Specific language can be found in the highlighted portion on Page 3 of the attached document. Under the section titled “Plan of Care and Scope of License” the note states “Services of unlicensed clinicians who are training under the supervision of a licensed clinician cannot be billed.” While PCA attempted to advocate for a different interpretation of the legal issue, Highmark has held fast that legally, they may only issue payment to clinicians holding a valid PA license to practice. (Click on the link below)
Highmark Policy Clarified
This impacts all individuals that do not currently hold any type of Counseling, Therapy, Social Work, or Medical Board license(s) in the Commonwealth. We will continue discussions with Highmark leadership in the coming days to work towards a resolution that best serves both current and future Pennsylvania counselors, as well as their clients.
These are difficult times for many agencies, providers, and clients, and the PCA Government Relations Committee has already begun outreach with PA legislators. We ask that you take a moment and click the link below to share how this decision is directly impacting you and your clients so that we may bring the severity of the situation to the forefront. We will continue to work diligently to advocate for all counselors and will provide you with additional information as it becomes available to us.
If you are interested in becoming directly involved with PCA’s advocacy efforts, you may email advocacy.pca@gmail.com for more information.
In solidarity,
Ashley Deurlein
55th President
