Treatment pauses help prevent clients from accumulating large balances that could create additional financial hardship. They are called “pauses” because the goal is for the client to resolve the billing issue and continue receiving care.
Clinicians can often help prevent treatment pauses by reminding clients to pay their copay during the session or by briefly walking them through the process in the Client Portal. This is especially important for:
- Telehealth sessions
- Sessions with minors
When working with minors, involve the parent or guardian whenever possible. A parent can add a card on file in the Client Portal, allowing copays to be charged without needing to attend every session.
When the Billing Team Initiates a Treatment Pause
The Billing Team will notify the client via TN Messaging if treatment must be paused due to billing issues.
A treatment pause may occur for any of the following reasons:
- Medicaid coverage has terminated
- Commercial insurance coverage has terminated and there is a large outstanding balance
- Large outstanding balance, typically $200+
- Outstanding balance of $20+ that is more than 14 days old
Actions Taken by the Billing Team
When a treatment pause is initiated, the Billing Team will:
- Cancel all future sessions.
- Add a cancellation note explaining the reason for the treatment pause.
- Add the label “Treatment Paused” in the client’s preferred name field.
- Send a message via TN Messaging explaining the reason for the pause.
- Upload a Billing Statement to the Client Portal.
Message Sent to the Client (TN Messaging)
Clinicians can review TN Messaging to see communication between the client and the Billing Team.
Example message sent to the client:
Hi Jane Doe,
Regrettably, we must temporarily pause treatment and cancel all upcoming sessions until you reply with one of the options below. This step is taken to prevent further financial complications.
Please review the Outstanding Balance statement uploaded in the Documents tab. If you would like to make a payment, visit the Billing tab in the Client Portal, where you can pay the full balance or submit a partial payment.
Please reply and let us know how you would like to proceed:
- I will pay the balance (in full or through payments) and reschedule with my provider within ~30 days.
- I will work to reinstate my insurance/Medicaid with a retroactive effective date that covers the outstanding sessions.
- I will reinstate my insurance/Medicaid with a future effective date, make a partial payment, and provide payment plan details, then resume services.
- I will obtain new insurance, make a partial payment, and provide payment plan details, then resume services.
- I will sign the private pay agreement, make a partial payment, and provide payment plan details, then resume services.
- Terminate treatment
Please note: If payment plan terms are not followed, treatment may be paused again.
Please reply here and let us know how you would like to proceed.
When Clinicians Can Restart Treatment
Clinicians may resume treatment when one of the following occurs:
- The Billing Team confirms the issue is resolved, or
- The “Treatment Paused” label is removed from the client’s name.
If needed, clinicians may contact the Billing Team via email or chat to confirm whether a recent payment has been made.
What Happens When a Treatment Pause Is Lifted
When billing issues are resolved:
- The “Treatment Paused” label is removed from the client’s name
- Removing the label is a manual process by the Billing team, this is no automation that automatically remove the label when the client pays their bill.
- The client is notified via TN Messaging that they may schedule an appointment or that their upcoming appointment has been reinstated.
If the Client Does Not Respond
If the client does not respond, obtain new insurance, or make payment:
- Review the Pro Bono Policy for possible options that may be offered to the client.
- If there is no activity in TN for 30 days, a To-do will be generated to begin the termination process.
At that point, follow the standard procedure outlined in Termination Note Expectations & Procedure.
FAQs
Are clinicians still paid even if the client doesn't pay their copay or fees?
- Yes. Clinicians are paid based on the service code rendered, not on whether payment has been collected from the client or the insurance company.