I am currently credentialed with the following insurance provider panels:
- Blue Cross/Blue Shield
- Choice Care
- Horizon Behavioral Health
- Mines and Associates
If your insurance company is not on this list, call and inquire about “out-of-network” benefits.
In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I will provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of my fees. It is very important that you find out exactly what mental health services your insurance policy covers.
You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course I will provide you with whatever information I can based on my experience and will be happy to help you in understanding the information you receive from your insurance company.
Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care” plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more counseling after a certain number of sessions. While a lot can be accomplished in short-term counseling, some clients feel that they need more services after insurance benefits end.
You should be aware that there are certain potential risks associated with filing mental health insurance claims. When filing a claim, the therapist must submit a formal diagnosis. This diagnosis then becomes part of your permanent medical record. This often results in the insurance company labeling the consumer with a “pre-existing condition.” For example, if your therapist submits a diagnosis of “depression,” this preexisting condition can later raise your life insurance premiums or make it difficult to obtain health insurance.
In addition, some clients are concerned that the filing process often requires a breach of client confidentiality, especially for in-network reimbursement. To meet the requirements for in-network reimbursement, the counselor must submit an official client diagnosis, an ongoing progress report, and occasionally a treatment plan. This process requires that the therapist divulge personal information about the client and his or her counseling work. In addition to being added to your medical record, this information is evaluated by your insurance carrier’s case manager. A case manager typically has minimal if any psychological training, and makes decisions about your approved treatment based on financial rather than mental health concerns. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it.
It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above. In some instances, I am able to work with you to arrange a reduced fee, provided you meet certain requirements. Contact me if you have unanswered questions about fee or the insurance filing process.