Beginning January 14, 2019, I am no longer a participating provider for Cigna, Oxford Health Plans, United Behavioral Health, United Health Care, UMR, or any Optum Behavioral Health plan.
I remain a provider for Medicare and Medicaid in New Jersey and New York. I am in-network for the following Beacon Health plans:
NY – MEDICAID (CHCS) NY – MEDICARE (CHCS)
NY-HMO (CHCS) EMBLEM HEALTH HMO
EMBLEM HEALTH NON HMO NEW YORK STATE EMPIRE PLAN (NYSHIP)
CRYSTAL RUN HEALTH PLAN – HMO MVP COMMERCIAL NON HMO NETWORK-IPA
EMBLEM HEALTH MEDICARE EMBLEM HEALTH MEDICAID
VALUE OPTIONS COMMERCIAL NON HMO
It is your responsibility to maintain your health insurance coverage and to notify me at least four weeks in advance of any possible or pending changes in your health insurance.If you fail to keep your insurance benefits up to date or to obtain proper authorization (if necessary) for treatment, you are responsible for payment in full for sessions that are not covered. By federal law, this does not apply to Medicaid beneficiaries.
If you have “out of network” benefits through a PPO plan, you may submit the bills to your insurance company to receive partial reimbursment. Please notify me if you plan to do this so that I can provide you with all of the information you will need to complete the HCFA-1500 form.
BEFORE YOU DECIDE TO USE YOUR HEALTH INSURANCE…
DID YOU KNOW?
Your treatment may not be as confidential as you think.
Commercial and governmental health insurers have the right at any time to audit records or request additional information about your treatment. Your consent is not required and you will not be informed of this disclosure by the insurer. Your consent is implied by the use of your health insurance benefits for treatment, even if these are “out-of-network” benefits.
Current federal legislation does not adequately ensure the security of your confidential health information. All insurance companies keep electronic records of your private medical information. While this data is supposed to be kept confidential, there are routine security breaches.
You must be labelled with a psychiatric diagnosis.
You must be given a psychiatric diagnosis in order to have your sessions paid for by your health insurance. This psychiatric diagnosis will remain as part of your medical record.
Your doctor may not have control over your treatment.
All Managed Care Companies (MCCs) involve direct clinical management by the company’s case managers. Who? Case managers are administrators who have never met you and apply formulas and general guidelines in an attempt to override the therapist’s expertise and personal knowledge of the client. The job of the case manager is to keep costs to an absolute minimum. Although some of them have degrees in the health professions, they may not have any practical experiences with psychotherapy and are often less qualified than your therapist.
Case managers can limit your access to treatment and determine the type of treatment you are provided, without your consent and regardless of the clinican’s professional recommendation.
You are not guaranteed to receive your mental health benefits.
The benefits advertised by your insurance company are not always accessible to you. Case managers demand ongoing “proof” that you require treatment and may limit your benefits if they do not deem that your suffering is “severe” enough. Hours of paperwork, telephone calls, and faxes are generally required in order to obtain full benefits, resulting in considerable delays in reimbursement and more detailed disclosure of your personal issues.
Government and private insurance companies can rescind your health care payments to your doctors.
Insurers can and do audit health records to review the “medical necessity” and appropriateness of the treatment. If they do not find that the records do not sufficiently document their standards of medical necessity, in a post-treatment or mid-treatment analysis they can decide to NOT cover the treatment– and then recoup their payments.. In other words, after you receive services and the clinician has been paid, a retrospective audit can rescind the coverage and take back the fees they paid! Some audits are random and some are targeted toward clinicians who provide a lot of treatment, who work with people with chronic conditions, or who offer longer sessions.