Health Insurance Information

Proceed With Caution!

When considering the use of your insurance for the reimbursement of my services you need to be aware that at a minimum I must give them a diagnosis. Even with a seemingly innocuous diagnosis like "Adjustment Disorder" you henceforth have a Mental Disorder label, which can result in being denied on applications for disability, life or other health insurance. Further, I cannot guarantee your confidentiality. If you have an insurance policy which is reviewed by one of the managed health care companies I must provide them with detailed information as to your personal history, sexuality, HIV status, drug and alcohol use, problems and progress. Failing to do so will mean denial of benefits. I cannot guarantee this information will not be leaked, in some cases albeit rare (and illegal), to your employer or the Medical Information Bureau (a National database used by insurance companies). Further, if your health insurance is managed by an HMO or PPO you may take these risks only to find that the company will only authorize a small number of sessions averaging six or less.

More information see my Shrink Rap article: "I Quit"

Also be sure and read the article, "Eleven Unethical Practices of Managed Health Care"

Obtaining Authorization:

Most insurance membership cards have a 1-800 phone number that you need to call for authorization of mental health benefits. Your insurance company may direct you to a managed health care company whose job it is to "manage" your use of my services (translation: keep the cost down) Call the number and:

1. Ask if I am covered: (as an out-of-network provider)

If they ask about my credentials:

I am a licensed clinical social worker (LCSW), license number: 978021.

I am a board certified diplomate in clinical social work.

My liability insurance is currently at $1 mil/$3 mil.

Under Colorado law I do not need, nor do I have, regular supervision by a psychiatrist: Colorado Revised Statute 10-3-103(3)(a)(II)(A), effective July 1, 1991: "Licensed clinical social workers are considered autonomous providers of mental health services and psychiatric supervision cannot be a precondition: insurance reimbursement is now mandated by law."

2. If they tell you I am a preferred provider and am on their list or provider panel, tell them I have resigned effective May 1^st, 1996 from all provider panels.

3. What are your benefits?

Deductible, copay, annual limits, maximum paid per session/per year, number of approved sessions, type of approved sessions (some don't pay for group or couples therapy). Any other restrictions or limitations?

4. What is required of me, as your therapist, ie. case reviews by phone or written reports?

Have them forward this information (with the awareness that there will be a charge for my time meeting these requirements).

Filing a Claim:

1. Ask your insurance company to provide you with an insurance claim form. Fill in the top portion, including your authorization number. Do not sign the box authorizing payment directly to me. If they do send the check to me, I will sign it over to you, or if you prefer, credit it to your account.

2. I will provide you with a carbon receipt for services at the end of each session. Keep one for your own records, and attach one to your own insurance claim form (or ask me for a HCFA claim form). This receipt will serve in lieu of the Physician or Supplier Information Section.

3. Start a file and keep track of what insurance actually pays for. Be prepared for them to make mistakes, and for payment to take about 2-3 months. If it takes longer, get after them.

If you have problems with your insurance or managed health care company be sure your Human Resources Benefits Office is aware of your difficulties.

Last messed with November 15, 2001