In order for you to make an informed choice, please consider the information below. Accessing your insurance mental health benefits has pros and cons. Do not hesitate to bring any questions or concerns to my attention.
Lack of Confidentiality
All managed care plans use case managers. If you access therapy through your managed care plan (“Plan”), I must disclose significant information about you and your treatment. Neither you nor your company have a single case manager; multiple people will have access to your information. This information is used by the Plan to determine whether therapy is “medically necessary” (in other words, will they reimburse at all for the service and, if so, how much). Many Plans have hired managed health care companies to make these decisions. So, to use your health insurance, information must go to both the managed care company and the insurer itself.
You give me consent to release the information to the Plan. That is where the control ends. Both purposeful and accidental disclosure of mental health information happens all too frequently. Once any of your information leaves the therapist’s office, there is no guarantee that it will be kept confidential.
Difficulty accessing providers
Provider lists- people who have agreed to take a reduced fee to be listed as “in network” - appear to offer numerous choices. After a few calls, you may find that new clients are not being taken, that schedules do not coincide, or that the person is no longer on the provider list. Experience shows that it can take 3 months or more for the insurance company to update their lists. If the person you want to see (based on a friend’s recommendation), is not “in network, you may not be able to use your benefits.
Difficulty getting treatment authorized
Your Plan has their financial survival at the heart of their decisions. They will keep their costs, i.e., the amount they pay out, to a minimum. Thus, getting approval for mental health treatment often becomes cumbersome and time consuming. Even the new parity laws do not guarantee that the Plan will authorize or pay for treatment.
To use your benefits to the fullest, you must 1) choose someone who is “in network” with the insurance company, 2) choose someone who is in network with the managed care company, and 3) for some, get a referral from your primary care physician.
Most Plans parcel out the authorized treatment both in number of sessions and in time frames within which to use those sessions. Regardless of your plans "annual maximum," we may gain authorization for far fewer sessions. Extending these sessions, or the time frame within which to use them, requires more paperwork. There may be a disruption in treatment while waiting for this approval.
Misdiagnosing or misrepresenting to get treatment authorized
All insurance plans require a diagnosis in order to provide payment to a therapist. Misrepresenting a client’s mental health issues is unethical and illegal. Some Plans will not pay on certain diagnoses. Some Plans will not cover marriage counseling/therapy. Some do not cover family therapy. Some define family therapy as a minor child being present. Thus, a client will have to pay out of pocket for these services as it is unethical and illegal to claim individual therapy when that is not what occurred.
Only You Can Decide
Please take the time to consider these points. Bring any questions or concerns and we will discuss them.
I realize that mental health treatment is not affordable for many without the aid of their insurance. If you must use your insurance to afford treatment, then we will work together to gain authorization and payments for your treatment. Bear in mind that, regardless of what the insurance company says or does, you are ultimately responsible for the cost of your treatment.
If you would rather not use your insurance but cannot afford the full fee, talk to me. I am willing to discuss a realistic reduction in fees in order to make the process easier on both you and me. Not using your insurance has two very important benefits: no diagnosis needs to be made, and your personal health information does not leave my office for the sake of authorization/payment of treatment.
Fees and Networks
Individual, family, or couple's sessions are $150; groups (when running) are $75 per member per session. Currently I am in-network with BC/BS (PPO and Indemnity plans), CIGNA (PPO and EAP plans), Carebridge EAP, HMS EAP, and ComPsych EAP. To access out of network benefits, you pay the full fee and receive a receipt to submit to your Plan.
revised 1 January 2013