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Articles for Adult Clients
Unless other wise specified, all articles appearing on this web page have been written and copyrighted by Bernard Ivin. If an article has been written by another author, his or her name will be referenced at the end of the article.
The web page is currently going through a major revision and therefore does not have all of our articles available for viewing. Please check this web page periodically for additional article entries.
Dealing With Insurance Providers:
Mental health services can be expensive. While insurance can help offset the cost, it can also be a source of frustration and confusion. To determine which mental health services are available to you under your insurance coverage and to help prevent complications, delays and/or unexpected costs, it is crucial that you read your insurance policy or handbook carefully and/or speak to an insurance representative prior to contacting a potential treatment provider. Check your insurance card for a toll free telephone number that will put you in contact with an insurance representative who can answer your questions.
There are typically three types of insurance coverage -- traditional, preferred provider (PPO), and managed care (HMO).
Traditional Plan: A traditional plan gives you the most options. You can see a licensed treatment provider of your choice, pay the fee and submit the claim for reimbursement. The percentage of the fee you are reimbursed may range from 50% - 100% depending on your policy. Some policies require that you pay a deductible prior to being eligible for reimbursement.
Managed Care Plan (HMO): A managed care plan requires you to see a treatment provider who is contracted with your insurance company (referred to as a "in-network" provider). With some policies you may need a referral from your primary care physician to initiate treatment. You pay a co-pay ranging from five to twenty-five dollars at the time of service. The treatment provider submits your claim to the insurance company and is paid the balance of the fee directly from the insurance company. Under the HMO plan, initial and ongoing sessions are subject to pre-authorization and review by your insurance provider.
Preferred Provider Plan (PPO): A preferred provider plan allows you to see either a contracted ("in-network") treatment provider at the cost of a co-pay or a licensed treatment provider of your choice. Under the PPO plan, if you choose to see a treatment provider that is out of network, the fee reimbursement is typically lower then it would be with the traditional plan.
In speaking to your insurance representative, it may be helpful to ask the following questions (it is crucial that you document all conversations, dates and names of contact personnel):
- All plans: What type of policy do I have? Traditional? Preferred Provider (PPO)? Managed Care (HMO)?
- All plans: Are mental health services covered?
- Traditional plans: What is the percentage that I will be reimbursed?
- Traditional plans: Do I have to pay a deductible prior to receiving reimbursement? If so how much is my deductible (e.g., $500, $1000, etc.)
- HMO plan - Do I have to pay a co-payment? If so, how much is my co-payment?
- All plans: Are both outpatient and inpatient treatment covered?
- All plans: Do I need a referral from my primary doctor? If so, what is the best procedure for obtaining one?
- All plans: Do I have to start with outpatient treatment prior to accessing inpatient treatment?
- Traditional plan: If I receive individual outpatient treatment, what credentials does the treatment provider need in order for me to receive reimbursement for the treatment?
- Traditional plan: Is there a limit on how high the professional’s charge may be (e.g., $120, $250, etc. per session), what is the maximum fee for which I will be reimbursed?
- All plans: What is the total amount the insurance will pay on a yearly or a per contract basis for mental health services (e.g., $5000, $10,000, etc.).
- All plans: If the parents or family members of the identified client need to be seen separately, do specific rules apply? What are those rules? How does the treatment provider need to document those sessions in order for me to be reimbursed?
- HMO type: Are there "out of network" benefits (PPO option) available? How do I obtain those "out of network" benefits? How do those "out of network" benefits differ from "in network" coverage? What is the percentage of reimbursement? Is there a deductible?
- All Plans: If my child is covered by more than one insurance policy, do special rules apply? What are they? What are the steps I need to take in processing the claim and ensuring reimbursement?
- All Plans: Is there anything else I need to know to ensure that I can obtain the type of treatment I am seeking, that my claims will are processed expediently and properly and that I receive the correct reimbursement?
- All plans: What are the steps I need to following in obtaining the services that I am seeking?
If you have an HMO policy, ask your insurance representative for a list of "in-network" providers. When selecting a treatment provider from a list of unknown names, it is strongly recommended that you follow the recommendation outline in the selecting a psychotherapist section outlined on this week page prior to scheduling your first appointment.
If you are on public assistance and you have Medicaid as your insurance, follow the strategies outlined above for an HMO policy.
Choosing The Right Therapist:
Where do I start?
A good starting point for obtaining counseling services is to consult with your primary care physician. Have the doctor do a physical examination to determine if any medical illnesses may be contributing to your emotional/behavioral difficulties. If your symptoms are not related to a medical condition, psychiatric treatment may be recommended. Ask your doctor to provide you with the names and phone numbers of at least three suitable therapists. In addition to your doctor, it may also be helpful to consult family and friends who have gone through the treatment process. The best therapist recommendations often times come from someone with first hand experience.
Determining The Best Match:
To help determine the probability of a good match between you and a potential treatment provider, it is crucial to conduct a telephone consultation and to ask a lot of questions. Consider your first telephone contact and first therapy session as a two-way interview. While the treatment provider assesses you (or your child’s difficulties) and treatment needs, you are assessing the treatment provider’s personality, treatment philosophy and skill level.
Ask the treatment provider the following questions:
- Do you accept my insurance ____________________?
- What are your fees?
- What are your credentials? What is your professional license?
- Do you have experience working with what I think are my ( my child’s) difficulties? How many patients with my (or my child’s) difficulties have you treated?
- Do you have experience working with patients my (my child's) age? What percentage of your caseload are patients my (my child's) age?
- What is your treatment philosophy?
- Do you have any specialized training?
- What is the average length of treatment for my (my child’s) type of difficulty?
- If my child does not want to come to therapy or is uncooperative with you, how will you handle that?
- Do you communicate and work with school staff if necessary?
If you are still not sure, then ask:
- What are your strengths as a treatment provider?
- Is there anything else you think I need to know as a potential patient (a parent/guardian of a potential patient)?
Since most of us do not have ample experience in directly questioning a professional about his/her expertise, it may feel uncomfortable asking these kinds of questions. I urge you to put aside your discomfort. Not asking questions and adequately assessing the compatibility between you and a potential treatment provider, increases your risk of wasting your time, money and hope.
The type of responses you get to these questions may vary greatly. What often matters as much as the answers given, is the openness and sincerity with which they are given. From a credentials standpoint, you want a licensed treatment provider (or someone under the direct supervision of a licensed treatment provider) with both experience and specialized post-masters training.
In making a final decision about a treatment provider, ask yourself the following questions:
- Did the treatment provider sound professional, knowledgeable, warm and considerate?
- Was I comfortable speaking to this treatment provider?
- Did the treatment provider welcome my questions? Did he/she answer the questions fully or did I have to probe for more thorough responses?
- Was the treatment provider patient with me or did I feel rushed?
- If you left a message on the treatment provider’s voice mail or answering service -- Did the treatment provider return my call within a reasonable amount of time?
I wish you the best of luck in finding a treatment provider who can most effectively serve your needs.
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Strength for Change, LLC
Counseling & Self Development Center
22 Howard Blvd., Suite 101
Mount Arlington, NJ 07856
(973) 770-7600
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