Considerations If You Choose
Third-Party Reimbusement
The following information may be useful to you if you
choose third party reimbursement to pay for your psychotherapy.
1. You are encouraged to talk with your psychotherapist if you
are considering filing for third party reimbursement. She or he can
assist you in understanding the language and organizational procedures
that accompany third party reimbursement and in reviewing the
advantages and disadvantages of third party reimbursement versus
self-pay.
2. Each insurance or managed care company has its own criteria
for authorizing sessions. By seeking reimbursement from a third party
payor, your psychotherapist may be required to provide information
about your diagnosis and treatment to the company that administers the
third party reimbursement. You are encouraged to discuss with your
psychotherapist exactly what kind of information is being requested for
both initial and continued authorization of benefits. Sometimes
insurers will submit medical data to national data banks where the
material then becomes accessible to other insurers and, potentially, to
other parties. You should evaluate the possible impact for you or your
family if this information becomes accessible to others.
3. The rules of confidentiality about how insurance and
managed care companies record and use information provided to them may
not conform to the customary and usual therapeutic norms of
confidentiality. Although it generally is not the case, information
contained in medical records maintained by third party providers may
sometimes have possible implications for future employment, future
insurance, security clearances, child custody and other legal
involvements.
4. Third party reimbursement usually requires the routine and
periodic exchange of information between your psychotherapist and the
insurance/managed care carrier. Sometimes this information will be
recorded in a computer data bank and/or transmitted via FAX or
electronic communication. Your psychotherapist cannot guarantee that
appropriate security measures are utilized by any insurance/managed
care company regarding accuracy in the exchange and handling of such
material.
5. Filing for third party reimbursement requires your
treatment be "medically necessary." In such circumstances, your
psychotherapist usually will be asked to assign a diagnostic label from
the Diagnostic And Statistical Manual of Mental Disorders (DSM-IVR) to
justify your treatment. It is advisable to discuss such diagnostic
information and the implications of having a mental health diagnosis
attached to your medical records with your psychotherapist.
6. Many third party reimbursement plans limit the number of
sessions available to you. Your access to benefits is not necessarily
guaranteed by many insurers. What you and your psychotherapist
determine to be clinically appropriate for your therapy may not be
consistent with the criteria for medical necessity as authorized by
your insurance/managed care company. Therefore, the frequency and type
of clinical services available to you may be restricted if you file for
third party reimbursement, regardless of whether your psychotherapist
recommends such services.
7. Your psychotherapist assumes responsibility for the timely
filing of requests for additional sessions when you are utilizing third
party reimbursement and for keeping you informed of the status of these
approvals. Provided your psychotherapist fulfills these
responsibilities, you may be expected to accept financial
responsibility for direct payment of any charges which are not paid by
your insurance or managed care company. However, some third party
reimbursement plans place restrictions on services that can be offered
to a client outside the framework of the contract that has been agreed
upon between that company and the psychotherapist.
8. When you use third party reimbursement to pay for your
therapy, you accept responsibility for any co-insurance and deductibles
not covered by your health insurance policy. These charges generally
are available upon inquiry from your insurance company or
psychotherapist.
9. Some psychotherapists may charge an separate administrative
fee to offset the additional time and paperwork involved in processing
the requirements for third party reimbursement. Because insurance and
managed care companies will seldom pay for such administrative fees,
you usually will be required to pay such charges. Some third party
reimbursement policies prohibit providers from charging this kind of
additional administrative processing fee.
10. Many insurance and managed care companies restrict or deny
third party reimbursement based on the credentials of the provider or
the treatment method. The criteria for coverage generally are available
upon inquiry from your insurance company. Your choice of
psychotherapist may be limited to those who have a contract with your
health insurance carrier. Some carriers publish a list of
psychotherapists from which you are allowed to choose, some may assign
you a psychotherapist, and others may allow your primary care physician
to make the referral.
We hope you find the above information and concepts of
choice, control and confidentiality helpful in making your decision.
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