Refer Someone To Our Services
At Diversus Health, we provide treatment for clients referred from external providers and the criminal justice system. Services will be rendered and provided by our qualified providers who will determine the level of care necessary by aligning with our assessment procedures in accordance with the OBH requirement standards for serving our referral clientele. Contact us to refer someone today.
Summary Of Insurance Reimbursement Rates For Psychotherapy
Mental health reimbursement rates vary dramatically. They depend on your:
- your location,
- and the service map for each insurance company youre applying to.
Your reimbursement rates are most dramatically influenced by your education and license, baring living in a few locations that are dying for more mental health providers .
Strategically speaking, your first big decision is your level of licensing and continued education you have sought or will seek. Next will be picking an area that is undeserved to the best of your estimation. Finally, consider choosing a specialization that fills in a service gap that is regularly sought after.
From there, pick which insurance companies youre most interested in working with depending on the demographic you aim to serve. Some companies may pay less but provide you a higher inbound flow of clients , whereas others might be very challenging to get in-network with but pay much higher .
For specific recommendations for credentialing in your state, feel free to reach out to us at TheraThink for help.
Understanding The Appeals Process
If a health insurance company refuses a claim for rehab services, the insured has a right to file an appeal. The insurance company will provide information to the insured on how to file an appeal.
It can help to know some helpful tips when a claim for a rehab service has been denied.5
One of the best pieces of advice for working with an insurance company is to view the process as collaborative rather than adversarial. An insured person and an insurance company have a contractual relationship, so ultimately, the terms of the contract and their interpretations will govern the process. An insurance coordinator at a rehab center can help to set an insureds expectations, so there are no surprises.
Keep in mind that rehab centers repeatedly bill for the same types of services, and they tend to know if those services are covered. You dont have to navigate the insurance coverage process by yourself the rehab center and insurance company can help.
Don’t Miss: How To Stop Cell Phone Addiction
Drug Counseling Insurance Coverage
Individuals in need of treatment can verify their insurance coverage options prior to seeking treatment. While rehab centers usually have a human resources or administrative representative available to assist potential clients in navigating their insurance plans, the insurance company is still the primary resource for gaining this kind of information. A simple phone call can clear up any confusion. Questions to ask insurance companies about an individuals policy coverage include:
- Is substance abuse treatment covered?
- Is the policy deductible met yet?
- Is drug counseling a covered service, and at what percentage is it covered?
- Is there a copay?
What Types Of Services Are Covered
Each rehab center provides a different array of services, and the insurances they accept will vary. Some will be in-network with certain providers but accept others on an out-of-network basis. Always be sure to ask a rehab center upfront which insurance companies they are in-network with. The facility may tell you they take most insurances but that may not mean they are in-network with them. You may be responsible for a much greater portion of the cost when you choose an out-of-network treatment facility.
Keep in mind that your insurance will likely only want to pay for services they deem necessary. This might make it harder for you to get coverage for alternative therapies or for luxury programs. Its always a good idea to ask any questions about coverage ahead of time so youre not surprised when you receive the bill after-the-fact.
Its always a good idea to ask any questions about coverage ahead of time so youre not surprised when you receive the bill after-the-fact.
If you do choose an out-of-network facility or you end up having to pay most or all of the costs on your own, the facility may be able to work with you to ease the burden of the costs. Some facilities will offer loans or financing to make it easier to get into treatment now and pay off the cost over time. Others may have scholarships or sliding scales to make treatment affordable for those in need.
Don’t Miss: How To Break Fast Food Addiction
Join A Provider Panel
Therapists interested in being directly reimbursed by insurance companies can join the insurers preferred provider panel. This usually requires a fairly intensive application process, and approval can take several months. Once the therapist is approved, however, the insurer directly pays the therapist for their services. Being on a provider panel may also offer some marketing benefits because most insurers have a directory of preferred providers that potential clients may use to find you.
Dr Matthew Edward Masters Md
Dr. Matthew Edward Masters is a medical doctor specializing in addiction medicine. He is also on the faculty at the Texas A & M School of Medicine in Round Rock, teaching courses on addiction medicine. Dr. Masters graduated from the UT Medical School of Houston and focuses on the 12-steps approach to therapy, as well as Cognitive Behavioral Therapy and Mindfulness-Based Therapy.
Dr. Masters offers a free 15-minute consultation, during which patients can discuss insurance coverage.
Contact These Leading Austin, Texas, Addiction Counselors for More Information
If you live in or around Austin, Texas, and you or someone you know is dealing with addiction, these counselors can help. As you select a therapist from the leading Austin, Texas, addiction counselors consider things like:
- Accepted insurance
- Therapeutic approaches
Addiction counseling is not a one-size-fits-all category, so take your time. Work with your counselor to develop a customized approach to your recovery.
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Talk with one of our Treatment Specialists!
COVID-19 Questions and Concerns
You May Like: How To Get Rid Of Video Game Addiction
Medical Necessity = On Your Record
If you use your insurance for therapy, you will have to be diagnosed.
Insurance companies only pay for services that are deemed medically necessary. In therapy, medical necessity is established by diagnosing a client. Furthermore, as clinicians, we have to demonstrate that a clients mental health condition is affecting and interfering with their overall functioning on a daily basis in a clinically significantmanner.
The problem is that many of lifes challenges, and the reasons why people seek counseling, are not mental health disorders, nor are they diagnosable. In this case, your insurance company will not cover treatment. Insurance wont pay for, Im considering divorce and need to talk to someone or I feel like an imposter and its making me anxious or I just lost someone close to me and I need someone to talk to.
Many people who seek counseling and therapy dont even have a mental health disorder! Theyre just looking to learn skills and strategies to manage and resolve relationship conflicts, increase productivity in their lives or careers, or improve their ability to manage lifes daily stressors.
Its unethical for a therapist to diagnose you for the sake of insurance payment and its considered insurance fraud.
Medicare Advantage Plans And Your Empire Plan Coverage
If you or your dependent enrolls in a Medicare Advantage plan, in addition to your Empire Plan coverage, The Empire Plan will not provide benefits for any services available through your Medicare Advantage plan or services that would have been covered by your Medicare Advantage plan if you had complied with the plan’s requirements for coverage. Covered mental health and substance abuse expenses under The Empire Plan are limited to expenses not covered under your Medicare Advantage plan. If your Medicare Advantage plan has a Point-of-Service option that provides partial coverage for services you receive outside the plan, covered mental health and substance abuse expenses under The Empire Plan are limited to the difference between the Medicare Advantage plan’s payment and the amount of covered expenses under The Empire Plan.
Recommended Reading: How Long To Get Back To Normal After Opiate Addiction
Substance Abuse Billing Can Have Millions In Receivables And Not Know It
Substance abuse billingis more complicated than it seams. This is when the problem becomes acute and financially damages the providers anticipated cash flow. This is because its extremely difficult for the provider to recover such insurance payments from the patient who has already received the check. Many times the client has cashed it and possibly spent the money. Obviously, the practice of issuing checks directly to patients instead of the provider has greatly impacted the cash flow of many providers. Florida drug rehabs West Palm Beach should make sure that the insured also executes an AOB and attests to it
Floridas controlling law in this area is Florida Statute 627.638 in which it states
- Section that an insurance contract may allow the carrier to send substance abuse billing payment directly to the provider of services if such directive is contained within the policy using appropriate language and there is an attested authorization of benefits from the insured.
- Section of this law it is clear that the duty to pay the provider exists when the insured and not just the patient has signed the AOB and attested to it
Should I Use My Insurance Or Pay Out Of Pocket
For many who seek counseling services, their privacy and confidentiality are more important to them than letting the insurance pick up the bill. In most cases your insurance provider will ask for a formal diagnosis and maybe even a treatment plan before they will agree to cover your counseling. Confidentiality is more secure when a third party does not have access to your private and personal mental health information.
Recommended Reading: Can You Be Addicted To Orgasms
Using Insurance To Pay For Counseling What You Need To Know
As therapists, we are required to adhere to an ethical code which states: Do No Harm. But what happens when we do and its outside of our control?
I still remember the day my client came in my office and said, Im really angry with you. She then told me how she had just been denied life insurance due to a diagnosis I had given her a diagnosis I was required to give her insurance company so they would pay for her therapy.
The myriad of emotions from that moment are what led me to stop directly billing insurance companies for mental health coverage.
If you are considering using health insurance to cover the cost of counseling or therapy services, you might think twice. Most people think that the cost of therapy is something they cant manage without using insurance. Most people think of utilizing insurance as a benefit.
However, what they dont realize is the potential cost of using insurance to pay for counseling.
Va Mission Act Of 2018
The VA Mission Act of 2018 further expands the medical network available to veterans. As of 2018, more family care providers, like live-in nurses, are eligible to join the network. Family care providers now have access to the PCAFC, a program designed to pay a monthly stipend to care providers who work with veterans.
Don’t Miss: What Addiction Does To The Brain
How Long Will I Be In Counseling
The counseling experience is different depending on your unique goals and needs, and the length of time you will be in counseling depends on the nature of those needs. Some clients have a very specific problem that can be worked through with a limited or specific number of counseling sessions. For others, counseling is an on-going process and they choose to receive counseling for a longer period of time.
The External Appeal Process
If, through the internal appeal process described previously, you have received a final adverse determination upholding a denial of coverage on the basis that the service is not medically necessary or is an experimental or investigational treatment, you have four months from receipt of such notice to file a written request for an external appeal. If you and the MHSA Program administrator have agreed in writing to waive any internal appeal, you have four months from receipt of such waiver to file a written request for an external appeal.
The Program administrator will provide an external appeal application with the final adverse determination issued through its internal appeal process described previously or its written waiver of an internal appeal. You may also request an external appeal application from the New York State Department of Financial Services . Submit the completed application to the Department of Financial Services at the address indicated on the application. If you satisfy the criteria for an external appeal, the Department of Financial Services will forward the request to a certified External Appeal Agent.
The External Appeal Agent’s decision is binding on both parties. The External Appeal Agent’s decision is admissible in any court proceeding.
Also Check: How Can You Get Addicted To Alcohol
What Is Addiction Therapy
Whenever you undergo a major life change, whether its coping with the loss of a loved one, moving to a new state, or quitting an addictive substance, your body and brain change uniquely to this dramatic shift in your life this where addiction therapy comes in.
Choosing sobriety may be one of the most anxiety-provoking and life-changing decisions you make for yourself. Its important to surround yourself with people in recovery and programs who help build you up to achieve your recovery goals. Addiction therapy pairs you with a licensed substance abuse counselor who specializes in helping people overcome substance use disorders and addiction.
The Mental Health And Substance Abuse Program Administrator Reviews Outpatient And Inpatient Treatment
After the initial certification, the MHSA Program administrator monitors your care throughout your course of treatment to make sure it remains consistent with your medical needs. The Concurrent Review is based on the following criteria and applies whether you choose a network or non-network provider:
Medical necessity of treatment to date
Proposed level of care and
Alternative treatment approaches.
The Program administrator must continue to certify the medical necessity of your care for your Empire Plan mental health and substance abuse benefits to continue.
Don’t Miss: What Is The Least Addictive Drug
Can A Mental Health Professional Charge The Same Fee For Insurance
A mental health professional cannot charge cash paying clients one fee and insurance-paying clients a different fee. You need to rectify this immediately by charging both these groups the same fee for the same service. If $115 is the usual and customary fee in your area, then you should charge that for everyone.
What Does It Mean To Be A Certified Insurance Counselor
Certified Insurance Counselors are recognized for their expertise and commitment to the industry. The Certified Insurance Counselor program is nationally recognized and highly respected insurance professional designation for agency owners, producers, agents, CSRs, brokers, and insurance company personnel.
Read Also: What Are The 4 Stages Of Addiction
Why Mental Health Insurance Companies Dont Release Reimbursement Rate Information
There are a few reasons that insurance companies wont let you know what youll be paid until you are accepted in their network.
The biggest reason they dont release contracted rate information is they change their rates daily, depending on a few factors and mechanisms. This is the primary reason you cannot find insurance reimbursement rates for psychotherapy online they are not set.
Your contracted rate will vary compared to colleagues in many cases because it is specific to you.
Certification Denial And Appeal Process: Deadlines Apply
Only an MHSA Program administrator peer advisor can deny certification. If certification for any covered service is denied, the Program administrator will notify you and the applicable provider of the denial and provide information on how to request an appeal of such decision by telephone. This information will also be provided to you in writing. You will have 180 days to request an appeal.
When you or your provider requests an appeal involving a clinical matter, a different Program administrator peer advisor will review your case and make a determination. The determination will be made as soon as your provider provides all pertinent information to the Program administrator peer advisor in a telephone review. You and your provider will be advised in writing of the decision.
If an appeal involves an administrative matter, it will be reviewed by an employee of the Program administrator with problem-solving authority above that of the original reviewer. Administrative appeals are reviewed by the MHSA Program administrator.
You May Like: How To Treat Addiction To Video Games
How To Code The Services
Billing the VA requires knowledge of numeric codes ranging from 5000-9999 to relay information about the medical diagnosis. Without proper training, its near impossible to discern which codes are applicable and when. The first 2 digits of a code are to determine the bodily location of the ailment and the affected systems. The last 2 reveal the illness and recommended treatment.
In rare cases, the code is hyphenated to include more digits. VA codes for addiction treatment will include the abused substance and required treatment.
Your Right To Appeal A Determination That A Service Is Experimental Or Investigational
If you have been denied coverage on the basis that the service is an experimental or investigational treatment, you must satisfy the following two criteria:
The service must otherwise be a Covered Service under the Policy and
You must have received a final adverse determination through the internal appeal process described previously and, if any new or additional information regarding the service or procedures was presented for consideration, the MHSA Program administrator must have upheld the denial or you both must agree in writing to waive any internal appeal.
Your attending physician must also certify that you have a condition/disease whereby standard health services are ineffective or medically inappropriate or one for which there does not exist a more beneficial standard service or procedure covered by the Plan or one for which there exists a clinical trial or rare disease treatment .
In addition, your attending physician must have recommended one of the following:
A service, procedure or treatment that two documents from available medical and scientific evidence indicate is likely to be more beneficial to you than any standard Covered Service or, in the case of a rare disease, a health service or procedure that is likely to benefit you in the treatment of a rare disease or
A clinical trial for which you are eligible .
Recommended Reading: Is Nicotine More Addictive Than Heroin