Do you accept insurance?
I accept insurance on a limited basis. Presently, I accept only Blue Cross Blue Shield PPO, Indemnity and certain Blue Choice plans. I do not accept HMO plans, and I am not a member of any other private insurance panels.
I feel that it is important to emphasize certain things about the use of insurance plans, particularly “managed care plans” (typically HMO) for mental health benefits. Firstly, when a family uses their insurance benefit for mental health care for their child, the insurance company is in essence subcontracting me to provide mental health services for their contracted clients. This means that the insurance company has the right to ask me for detailed clinical information about their clients and has access to my treatment records, making my treatment with my patients less confidential. It is also important to note that I am subject to the rules of the insurance plan, which necessitate the collection of copays at the time of visit and/or deductibles. Secondly, insurance companies often use arbitrary and less-than-scientific criteria to decide what type of and for how long they will cover clinical visits. For instance, many limit psychotherapy visits on the basis of whether or not there is a diagnosis of a “biological” mental illness (without defining what this entails or what other types of mental illnesses there are, if not “biological”). Also, insurance companies in general are more inclined to cover medication-only visits liberally but psychotherapy on a short-term basis only, making coverage more crisis-based rather than concerned with long-term improved emotional and behavioral functioning. Most families who seek me to be their child’s therapist are seeking the latter as opposed to the former, and this is not compatible with insurance coverage in many cases. There are so-called “parity” laws protecting the mental health care of minors, who technically should have “unlimited” visits under these laws. However, even when these laws are respected (which in my experience is not universal), this is typically accompanied by a significant amount of paperwork and administrative time for the treater, imposed by the insurance companies. In my practice, this takes away from my ability to focus my attention on the children and families whom I am treating, which is clearly where the focus should be.
I have no opposition to working with an insurance company in a reasonable way, but have no intention of working for one; that is, I do not believe that insurance companies should make clinical decisions regarding the treatment of the children under my care nor create tremendous administrative hardships for the treaters providing care. These issues tend to be less problematic for the plans which I accept, and this is the major reason why I do so. It is important for families to understand, even if they choose to use a form of insurance which I accept, and I have been given an authorization for services by the insurance company, that this does not guarantee that the company will actually compensate me for my services on a given date, nor does it mean that the company will cover treatment visits with me at the frequency and/or duration for which treatment is clinically necessary. If I am made aware of potential non-coverage by the insurance company, I will make every effort to alert the family ahead of time. However, services not covered by the insurance company will need to be covered by the family personally.
For those families who have insurances which I do not accept but wish to enter treatment with me, I am able to provide care on a fee-for-service basis and would be happy to provide them the necessary information so that they can submit a claim themselves to their insurance carrier, as many plans (usually PPO) contain out-of-network benefits that can be utilized. In some cases, a special agreement can be worked out between an insurance carrier (for which I am not an in-network provider) and myself. Should an out-of-pocket arrangement be necessary between a family and myself, I make every effort to keep my rates very competitive relative to the market for board certified Child and Adolescent Psychiatrists, as I recognize that treatment can be expensive for families.