Clinical Psychology Seattle Creating the life you want

Insurance

In order for us to set realistic treatment goals and priorities, it is important to evaluate the resources you have available to pay for treatment. It is important to remember that you always have the right to pay for my services yourself to avoid the issues described below.

If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of my fees.

  • The benefit of using such plans is that they defray the cost of treatment. The cost, however, is that you give up some level of the usual psychologist-patient confidentiality and that you may be guided by the plan in determining the type, amount or frequency of services they will cover. What they cover may not be the type, amount or frequency of services that you think you need.

  • Health insurance plans reimburse for psychotherapy when such services are deemed "medically necessary."What this means is that if you are experiencing significant trouble in your personal or work life, or significant distress, then you probably meet the criteria of medical necessity. If you are doing fairly well and are looking at psychotherapy as a means to learn more about yourself, expand potentials, or attain personal growth, this level of service is not usually covered.

  • Very few plans cover couples therapy or sex therapy.

Remember that employers are the ones who choose which level of mental health benefit to offer their employees, not insurance companies. So if you'd like a better type of mental health coverage option, use your voice within your workplace to try to bring about change.

It is very important that you find out exactly what mental health services your insurance policy covers. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course, I will provide you with whatever information I can based on my experience and will be happy to help you in understanding the information you receive from your insurance company.

If it is necessary to clear confusion, I will be willing to call the company on your behalf. Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available.

Duration of care

"Managed Health Care" plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person's usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions.

Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they run out before you feel ready to end your sessions.

While much can be accomplished in short-term therapy, some people believe that they need more services after insurance benefits end. And sometimes the psychologist believes that more treatment is needed to address longer-term or deeper issues that have been keeping a person from reaching his or her full potential.

Confidentiality

You should also be aware that your contract with your health insurance company requires that I provide it with information relevant to the services that I provide to you. I am required to provide a clinical diagnosis and sometimes I am required to provide additional clinical information such as treatment plans or summaries or copies of your entire Clinical Record. In such situations, I will make every effort to release only the minimum information about you that is necessary for the purpose requested.

This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it.

Insurance Plans Currently Serviced

I am a preferred provider with the following health plans:

  • First Choice Health Network
  • Premera Blue Cross (Blue Cross/Blue Shield)
  • Regence
  • Lifewise

I am continually adding more plans, so contact me if your plan is not listed above

HIPAA

The American Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a set of rules to be followed by health plans, doctors, hospitals and other health care providers. HIPAA took effect on April 14, 2003. In the health care and medical profession, HIPAA has created the assurance that all patient account handling, billing, and medical records are HIPAA compliant. My practices, and those of my billing service, are compliant with the HIPAA privacy rule, security rule, and transaction codes. As part of my informed consent paperwork, you will read about the provisions I have taken and how your "protected health information" will be handled should you choose to use health insurance to pay for part or all of your psychological services.

A brief consumer summary of the HIPAA privacy rule can be found at www.hhs.gov/ocr/hipaa/consumer_summary.pdf. A more in-depth summary from the US Dept. of Health and Human Services is at www.hhs.gov/ocr/privacysummary.pdf.

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