On any given day, a Los Angeles mental health clinic will see multiple patients with multiple types of insurance. A typical day could include a Medi-Cal patient through L.A. Care, followed by a tech worker with a high-deductible health plan, then a SAG-AFTRA member with entertainment industry coverage, and finally an elderly patient with both Medicare and Medi-Cal.

And of course, each type of insurance works differently, with authorization rules, documentation requirements and more changing from plan to plan. For example, entertainment industry plans often have networks that don’t match standard commercial insurance. Dual Medicare/Medi-Cal patients require specific billing sequences that, done incorrectly, result in automatic claim rejections.

Managing so many different insurance requirements can create administrative chaos for behavioral health practices: Claims get sent to the wrong places, authorizations get missed, and payments get delayed while staff try to figure out which rules apply to which patients.

Insurance Types Common in Los Angeles

L.A. Care billing splits services between organizations, which has become even more complex with the recent rebranding of Carelon Health to CareMore Health. Basic mental health services—such as routine therapy sessions—are now billed to CareMore, while specialty services are billed to LA County Department of Mental Health. Practices need to know which organization handles each patient’s specific services before submitting claims. If a practice bills the wrong entity, the claim will be denied. That means researching the denial, figuring out the correct billing entity, and resubmitting the claim—creating delays and extra work.

Entertainment industry insurance plans often work differently from typical employer insurance. SAG-AFTRA members, writers, studio employees, and others may have plans with different networks, authorization requirements, and billing procedures. These plans sometimes cover services that standard commercial insurance doesn’t, or they may have different copay structures.

Many patients have dual coverage such as having both Medicare and Medi-Cal. This means figuring out which insurance pays first for different types of services. Medicare typically pays first for most behavioral health services, with Medi-Cal covering what’s left. When practices bill them in the wrong order, the claim gets rejected and must be resubmitted with the correct primary payer information.

Large employers sometimes customize their benefits beyond what standard insurance offers. Major Los Angeles employers, such as hospitals, entertainment studios, and tech companies, sometimes negotiate unique benefit structures. Different employers who use the same insurance company may offer vastly different benefits.

Common Multi-Payer Billing Problems

L.A. Care’s health plan structure means practices sometimes send claims to the wrong organization. The organization that a therapy session should be billed to can vary depending on what level of care is needed. Submitting claims to the wrong entity means dealing with denials and resubmissions.

Dual coverage can create billing order complications. When patients have both Medicare and Medi-Cal, for example, Medicare needs to be billed first for most services. If practices bill Medi-Cal first—or forget to include Medicare’s payment information when billing Medi-Cal—the claim can be rejected.

Prior authorization requirements vary significantly between payers. Some entertainment industry plans require approval before starting ongoing therapy sessions, while others allow retrospective authorization. Authorization requirements can even differ between entities that handle L.A. Care services. When practices miss a plan’s requirements, they may end up providing services they can’t bill for.

Network status can differ even between related organizations, potentially leading to a practice incorrectly quoting patient responsibility amounts or submitting claims expecting in-network rates when the service will be processed as out-of-network. That could leave patients facing unexpected bills, and practices receiving lower reimbursement than anticipated. Patients who can’t afford unexpected costs may stop treatment, while practices lose revenue and consequently must spend time resolving billing issues. All this extra administrative work becomes a barrier to practice growth.

Streamlining Multi-Payer Workflows

Rather than simply confirming that a patient has L.A. Care, practices need to determine which organization handles their specific service needs based on the type of care being provided. This requires understanding how L.A. Care defines basic mental health services versus specialty mental health services.

When patients have multiple insurance plans, practices need to know which one to bill first. Entertainment industry workers sometimes carry multiple union plans, each with different primary payer rules. And again, the billing order is particularly important for dual Medicare/Medi-Cal patients, where the billing order determines whether claims get paid or rejected.

Practices can track authorization requirements by payer, including which insurance types require pre-approval for initial evaluations, ongoing therapy, psychological testing, or other services. Each step of the multi-payer billing process should be documented in repeatable lists. This ensures that any staff member can handle billing for the range of insurance types they may encounter.

All staff members who handle billing should be trained on researching unfamiliar plans and finding reliable information about billing requirements, so that billing operations don’t stop when one person is out. This is an important part of streamlining your workflow processes.

Technology Can Help

Electronic health record (EHR) systems that handle multiple entities can automate some of the complex billing decisions that Los Angeles mental health practices face. For example, storing payer-specific rules and requirements reduces the need to manually look up billing procedures for each insurance type. Storing authorization requirements by payer makes it easy to flag that certain entertainment industry plans require preauthorization for psychological testing while others don’t.

Real-time eligibility verification tools do more than confirm basic coverage. Advanced systems check specific details, including which organization handles billing for L.A. Care patients, what authorization requirements apply, and whether any coordination of benefits is needed. This information helps prevent billing errors before they occur.

Coordination of benefits automation ensures that primary and secondary insurance get billed in the correct order without manual intervention. These systems track which insurance should be billed first for different service types.

Why This Matters for Practice Growth

Efficient multi-payer management allows practices to serve diverse patient populations without creating administrative headaches that require additional resources to manage and stall practice growth. Practices that can handle L.A. Care, entertainment industry insurance, dual coverage, and customized employer plans can accept patients regardless of their insurance type, which significantly expands their potential patient base.

Streamlined billing processes reduce time spent fixing claim problems and speed up payment processing. Instead of having staff spend hours researching denied claims and resubmitting corrections, efficient processes help practices get claims paid on the first submission. This improves cash flow and frees up administrative time for other practice building activities.

Understanding Los Angeles’ complex insurance environment can become a competitive advantage. Many behavioral health practices avoid certain insurance types precisely because of the billing complexity, which means practices that master multi-payer management face less competition for those patient populations.