Managed care involves cooperation between the client, the provider and the insurance company to provide services as efficiently as possible.
1. Services that are determined to be “medically necessary.” Medically necessary may be defined as presentation of a DSM -5 Axis diagnosis (these are acute symptoms).
2. Conditions which can be treated by short-term, problem-focused, goal-oriented approaches whenever possible.
You and your therapist will need to discuss the nature of your problems and set specific goals for treatment that fall within these guidelines. Usually your insurance will then cover a limited number of sessions to work on your problem as intensely as possible, with the focus on eliminating acute symptoms. Your therapist will work with you to accomplish the identified goals in a cost-effective manner.
Your therapist has entered into an agreement with your insurance company to provide services within these guidelines. Your case may be reviewed by a utilization review/quality assurance group set up by the insurance company or professional colleagues. Your confidentiality will be maintained in this process.
Sometimes people enter therapy with a number of problems. Some problems may meet the conditions of your insurance coverage while others (e.g., individual growth, long-term personality issues, etc.) may not. If you desire to continue treatment for these or other non-covered conditions, your therapist will discuss your options with you.
Deductibles & copays are a contract between you and your insurance. There can be no negotiating of these fees. You are responsible for them. Late cancellations & no shows are also your responsibility as insurance does not cover them.
If you have any questions about your coverage, confidentiality, or other aspects of your treatment, please ask your therapist, Kenya Walker.