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Blue Mountains
Blue Mountains

Insurance Issues

 

Despite the changing health insurance landscape, like other health benefits, mental health benefits are managed by the companies who provide those benefits to assure themselves that the expenses they are being asked to pay for are warranted.  Although some contracts offered by these companies may be more generous than others, and some may be subject to greater oversight, all insurance companies manage the coverage they offer to their insureds.

In practical terms, this means that ultimately the insurance company may decide what services are acceptable to them and what mental issues they regard as deserving of treatment. These insurance decisions are often described as determining "medical necessity." Please be aware that "medical necessity" is NOT a clinical term, and it is not an assessment made by the clinician treating the patient. "Medical necessity" is what insurance companies use to describe the privately held criteria that they use to decide whether or not they will pay benefits.

In order to assess whether your condition and your treatment satisfies their criteria, insurance companies require that you give them access to your personal health information in whatever detail they might want.

In light of these issues, it is very important that you are as fully informed as possible about the nature and extent of your insurance benefits. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above.

If you do choose to use your insurance benefits, I provide a monthly billing statement that is itemized with standard information that you may submit to your insurance company for reimbursement. Because of the many different contracts each company issues, as well as the private nature of the criteria they use to decide claims, I cannot and do not guarantee that those expenses will be reimbursed.  Therefore, you (not your insurance company) are responsible for paying my professional fees.