Heavensfield

An important part of your health care is your “informed consent”. In order for you to make an informed choice, please click the read more button below to review our policy on billing your insurance for behavioral health services.

If you are a member of an HMO, PPO or other insurer that provides coverage for behavioral or psychological mental health services, please read the following before making your choice regarding accessing those benefits.

Managed care plans involve direct clinical management by the plan’s “case managers”. If you access therapist through your managed care plan, your therapist likely will be required to disclose a significant amount of personal information related to your case. This information may be used by the managed care company to determine benefits, which are allocated at their own discretion. This impacts your right to confidentiality, and it is possible that your information will be stored in a computer system, which could be accessed by any number of people.

Lack of confidentiality may adversely affect your minor children who are clients as well. Should they ever desire to apply for certain jobs or the military, the information in their insurance files could be accessed. It should be noted that this may be especially true with regard to Attention-Deficit/Hyperactivity Disorder, or Posttraumatic Stress Disorder which has been associated with lost employment and denial of admission to military service.

Due to the direct care management by managed care companies and their desire to keep costs at a minimum, getting therapy sessions authorized has become cumbersome and time consuming. Every plan has different requirements and standards for authorization.

Usually they require a number of hours a week of paperwork and phone calls by the therapist in order to get authorizations. Some will even deny participants therapy while approving medications.

Managed care plans allow a certain number of sessions per year for each plan. In cases involving abuse and trauma, this may not be enough to adequately address the condition which the client has sought treatment for. However, they may only authorize three or so therapy sessions at a time, which means significant and repetitive paperwork and phone calls back and forth from your therapist to your care manager. Sessions cannot be provided unless authorized, and sometimes this means there is a gap in treatment while more sessions are authorized. It is our opinion that this is not good clinical practice.

Some insurers will not cover treatment unless it is considered “medically necessary”. This may mean the client has to pretend they are “sick” or more impaired than they really are, in order to receive benefits. This situation puts both the therapist and the client at a disadvantage. Often the diagnostic or assessment sessions that are initially authorized are not sufficient to give an accurate diagnosis, yet the insurer will not authorize more visits without one. This puts the therapist in a position of having to take a “best guess” at a diagnosis, which is not in the best interests of the client. It is our opinion that no one should be given a mental illness diagnosis that is incorrect or exaggerated simply to get treatment paid for by the insurer.

Most insurance plans and managed care organizations have lists of professionals who are “in the plan”. However, this necessitates your seeing professionals who are on the plan and who have availability to insured/managed care clients. They may have no particular expertise with the issues you present to treatment.

The fees for psychotherapy at Health and wellness are considered “reasonable and customary” for psychotherapy with a master-level professional in this area. It is not feasible for us to hire the staff that would be necessary to handle insurance claims, especially given that many insurance companies and managed care plans will cover much less than our regular hourly rates. This consistent reduction in rates artificially lowers the “average” rates for therapists. While we are content not to raise our fees in line with other costs of living, we are not content to see them lowered by as much as 45%.

We hope this has explained some of the reasons for our policy of not accepting insurance directly. As stated in our consent form, we are happy to help you obtain reimbursement from your insurer by providing you with receipts or Health Insurance Claim Forms. We appreciate your understanding.

Founder: Cosette Dawna Rae