We believe that your treatment experience begins as soon as you make that first phone call. We try to make this difficult time as seamless and stress free as possible. To that end we have the following information that we hope you find helpful.
Since the inception of managed care some 15 years ago mental health coverage seems to have taken the biggest hit. It is often confusing and frustrating for the individual trying to understand their benefit. Today, mental health insurance takes on many different faces and presents with complicated issues. Hopefully the following information will help answer some of your questions.
Clients are generally covered for 20 to 30 visits a year. This can be a calendar year or a benefit year, depending on your plan. Keep in mind that you can’t always depend on that amount, as your plan may require you to also meet what they call medical necessity. Please be aware that if you see a psychiatrist for medication, these visits come out of the same pool of benefits.
You may or may not have an annual deductible and we have learned through experience that your benefit may change from year to year even if your insurance carrier has remained the same. Your insurance company will not notify us of any changes; you must keep us informed of changes such as new identification numbers, insurance company address changes, deductible information or co-payment information, just to mention a few examples.
Each plan or employer can also determine what type of services they will cover. For example: marital or couples counseling is often not covered by your insurance. Employers may offer EAP (employee assistance program) sessions. Since this is not information readily available to us, it must be given to us by you as the employee. EAP visits always require authorization and often are covered by a separate insurance company.
The Therapy Center has a staff of trained administrative assistants who will help you understand your benefits and answer your questions. We check your insurance as a courtesy and cannot be held responsible for incorrect information given to us by your insurance company. It bears repeating that it is imperative that we are notified as soon as any of your insurance information changes. Most companies require authorization and failure to notify us may result in nonpayment of your claims. Remember, ultimately you are responsible for claims not paid by your insurance company.