Personal
and Family Therapy
By a
Board-licensed Professional
(916)
966 - 7300 1845
Iron Point Road, Suite #180 Folsom, CA
95630
WHAT
TO EXPECT FROM INSURANCE
Know
whether your insurance has “out of network” benefits. The
therapists on your insurance company’s network list have all agreed to
work for a discounted fee, and may be very new to the field of
helping. If you can choose “out of network”
counselors, you
are able to choose someone highly experienced and based on how well
suited they are to help you.
If insurance covers your
counseling, don’t expect it to cover 100%. Consider it to be
an
aid that makes it possible to afford therapy. Many plans
won’t
cover video or telephone therapy, therapy by email, relationship
counseling, emergency sessions outside of regular hours, or more than
one 40 minute session in a day.
Almost all insurance plans are
based on “medical necessity.” This means you as an individual
must be diagnosed with the symptoms of a mental illness and treated for
that in order for coverage to apply, that is, be “medically necessary.”
Be prpared to cooperate with a managed care review, which will
establish that you still have enough symptoms for treatment to still be
"medically necessary," but that you are also making progress.
You may be asked to speak with a managed care reviewer or
fill out their questionnaire or even see your doctor for a medication
evaluation.
DOES YOUR PLAN MEET YOUR STANDARDS?
I want to apply your insurance coverage, but first I want to
be sure you know the facts and potential problems. Put your plan to
the test:
Can you select the health care
professional that
YOU prefer, or do you have to select from the list given by your
insurance plan or managed care company? (Are there "out of
network" benefits?)
Can you get therapy
for a marital problem if there is no diagosis? ( Many
representatives will tell you "yes." But realize that most
plans require that your care
pass a "medical necessity" test, meaning you have to be "treated" for
the symptoms of a psychological or emotional
disorder.)
Can you just refer
yourself or does your plan
require "pre-approval" or "pre-authorization" from their office staff?
Are there any financial incentives to the
doctor for not referring you to therapy or to the
health professional for not providing care? HMOs may have them.
What reports about your personal problems and
psychiatric diagnosis are required to be provided to the
managed care company or insurance plan?
How many staff have access to your confidential
information other than licensed therapists?
Is your confidential information kept on a
computer database ? To how many other offices does the
computer network connect?
If your plan advertises a benefit of 20 sessions per year,
under what circumstances can you use all 20?
Who reviews the "treatment
plan" for your "illness" and what are their qualifications ?
I urge you to carefully weigh the apparent low cost of a plan
that
doesn't answer these questions to
your satisfaction. Good plans will address your concerns. If
your
confidentiality is violated, you may not know the repercussions for a
long time, but they can be serious. If your emotional health is not
given first consideration, the
final "price" may be too much to pay.
Last Updated Aug. 7, 2016 by David
Hammer, MA, MFT