The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
Suspected child abuse or dependant adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
IMPORTANT INFORMATION ABOUT YOUR INSURANCE
An important part of your health care is your “informed consent”. In order for you to make an informed choice, please read on.
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.
2. Treatment Authorization
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.
3. Diagnosis Requirements
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.
4. Treatment Coverage
Most insurers do not cover marriage counseling or family counseling unless they are part of the treatment plan for a serious mental disorder or drug/alcohol problem. However, many times family involvement may be critical to the success of treatment. Also, most insurers will not provide coverage for what are considered “adjustment” issues, which may be less serious (though they can become serious) and treated relatively quickly. Billing a session as “individual” when it actually involved other family members is considered insurance fraud.
5. Usual and Customary Fees
The fees for psychotherapy at Shrewsbury Counseling Center are considered “reasonable and customary” for psychotherapy with a master-level professional in this area.
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 - heavensfield wellness)