Understanding Insurance

Understanding insurance coverage for mental health / behavioral health services
can be challenging. Benefits can vary significantly from company to company
and among different policies within the same company. Some policies (HMO’s)
limit which therapists a patient may see (and have those services covered).
Other policies (PPO’s, POS’s, etc) may allow more flexibility in whom the
patient may see (and have those services covered), but the patient may be
required to assume more financial responsibility to see clinicians considered
out-of-network. Patients utilizing these benefits may be required to pay a higher
deductible before services will be paid and the co-pay (the amount the patient is
responsible for at each visit) may also be higher.

Additionally, most behavioral health policies have a limit on the number of visits
or a dollar maximum that will be covered each year. In addition to the traditional
behavioral health benefits, some employers offer EAP benefits in which a limited
number of visits (generally three to five) are provided without the patient being
required to pay a co-pay.

It is also very difficult (impossible?) to keep up with all of the insurance company
mergers and although nearly every insurance company provides behavioral health
benefits, it is not uncommon for these benefits to be managed by a different
company than a patient’s medical benefits. As a result, our therapists may
actually be considered providers for insurance companies in which initially they
did not appear to be credentialed. To further add to the confusion, if a therapist
is not considered an ‘in-network’ provider, a therapist may be able to provide
services through a patient’s ‘out-of-network’ benefits.

Because understanding insurance benefits is so confusing, we gladly verify
benefits before setting an initial appointment. It is important to note that we
make every effort to accurately determine a patient’s insurance benefits. We
also submit a patient’s insurance claims and perform reasonable follow-up with
the insurance company. However, on occasion the benefit information provided
us by an insurance company may differ from a patient’s actual coverage. Actual
coverage can only be determined upon receipt of the insurance reimbursement
and the patient remains financially responsible for all charges.

Because each of our therapists is in independent practice at Associates in
Psychology and Counseling and because many insurance companies credential
therapists individually, not every therapist affiliated with Associates in Psychology
and Counseling is considered a provider for every insurance company. Follows
is a list of some of the insurance companies some of our therapists are providers
for:
AETNA, BEECH STREET, BLUE CROSS / BLUE SHIELD,
BEHAVIORAL HEALTH SERVICES, CAMERON & ASSOCIATES,
CHOICE CARE, CHOICE MEDICAL MANAGEMENT, HEALTH
CHOICE (ORHS), MEDICARE, PACIFICARE, PRIVATE HEALTHCARE
SYSTEMS, PSYCHCARE, UNITED HEALTHCARE, VALUEOPTIONS,
TRICARE/VALUEOPTIONS, WELL POINT,ETC.

Our therapists are also able to provide services through a variety of state
agencies including, CHILDREN AND FAMILIES, DISABILITY
DETERMINATION, VICTIMS COMPENSATION, VOCATIONAL
REHABILITATION, WORKERS COMPENSATION, etc.