Filing For Insurance Reimbursement

 

 

(Yes, this garish color-scheme is intended to attract your attention to this oft-misunderstood aspect of my profession!)

 

If you are utilizing insurance coverage (“out-of-network” plans only -- see below), in most cases I will either give you a bill to file with your insurance carrier, or file a claim with your insurer on your behalf.  However, unless special arrangements are made with me in advance, it is your responsibility to pay me in full at the time of service, and to collect the reimbursement from your insurance carrier (with your written consent, I will provide them with any additional information they may request -- assuming said request is within the bounds of my own professional judgment as to what is reasonable and in your best interest).

 

If you have questions about any of the above, or about any other policies or agreements regarding your psychotherapy, please feel free to bring them up with me at any time.

 

REGARDING “MANAGED CARE”

and

“IN-NETWORK” INSURANCE COVERAGE:

 

 

Dear client (and fellow, equal human being),

 

This letter contains important information for you, if you are using (or plan to use) any form of health insurance coverage to pay for part of the cost of your psychotherapy with me. 

 

My new policy:

As of January 1, 2013, I am no longer an "in-network provider" or “preferred provider” for any health insurance plan or “managed care” company.  This means that, if you plan to see me in psychotherapy with your insurance company paying for part of that expense, you will have to ensure that you have "out of network benefits for outpatient mental health services" as part of your policy provisions. 

 

Although I am willing to provide you with whatever form of bill you require, I will no longer be willing to communicate or negotiate with your insurer on your behalf – unless you directly authorize (and pay me) to do so (i.e., it will be YOUR responsibility to interface with them, should they fail to pay your claims in accord with your expectations).  If you would prefer not to handle this often unpleasant and confusing task, or if they insist that they must communicate with me in order for you to receive your benefits, you can hire me [at my regular rate, pro rata] to handle this task on your behalf.

 

 

What you can do if you do not currently have “out-of-network benefits for outpatient mental health services”:

Many companies and corporations allow their employees to change the form or extent of their employer-provided health insurance policies during some form of “open enrollment” period, usually somewhere toward the end of the calendar year. 

 

If you plan to work with me (or continue working with me), and you would like to have your health insurance plan pay for part of that expense, I strongly urge you to contact your “HR person” (or whoever can give you straight answers about your employer-sponsored health insurance coverage), so that you can start gathering (and interpreting) the information you will need in order to make an informed decision on which policy options to choose (assuming you are given any choices at all).

 

Knowing how most things work in the world of such bureaucracies, I suggest you start this process sooner than later -- and certainly well before the end of the calendar year.

 

 

To reiterate:

In order to be reimbursed by your insurance company for any services provided by me, you will need to have “OUT-OF-NETWORK coverage for outpatient mental health services” established as part of your plan provisions.

 

 

If you have questions or concerns about any of this information or how it may impact you specifically, please feel free to ask me about it in more detail.

 🦠😮🤭😱

As you may have noticed, "things are different now."

 

The advent of COVID-19 has pretty much required that psychotherapeutic encounters take place in the realm of remote digital communication -- at least for now.

Although I first assumed this would significantly weaken the power of the psychotherapeutic encounter in general, I have been happily surprised to discover that there are both disadvantages AND advantages to this medium of communication and connection.

Given a sane choice, I would much prefer to meet in person.  However, for the time being, my assessment of the downside risk of possible infection renders meeting in person highly undesirable, if not downright unethical (for one thing, my wife and office partner has a compromised immune system, which makes it out of the question for me to risk becoming a carrier).

We can utilize the platform of your choice (Skype, FaceTime, zoom -- or my HIPAA compliant web portal).  

 

I will make some suggestions about how to maximize our sense of connectedness with some simple adjustments...

© 2020 by Tony Rooney, Ph.D.