Insurance

How insurance works
To Use or not to use, your insurance.

Not all professionals will/may accept your ‘health insurance’ for the work they do with you. As a rule, when treatment meets certain specific criteria, treating therapists can accept your insurance, but not all wish to do so because in some cases, specifically required diagnosis information may, in the mind of the therapist compromise the client in some way (See HIPAA paragraph below) and/or in general, the procedures of some insurance companies are too unsatisfactory to work with.

All therapists, however, will provide you with the correctly worded receipt for you to file your own insurance claim or to present for tax credits.

For PPO’s
In your insurance card says your policy is a “PPO” (A preferred Provider Organization Plan), any licensed provider who chooses to do so can bill your insurance for partial payment of your session charge. You generally pay higher premiums for this PPO’s wider choice of doctors and facilities.

For HMO’s
If your policy is an HMO (Health Maintenance Organization Plan) the provider must be contracted to that particular insurance company and for your plan. Each therapist with COUNSELINGSANDIEO.COM lists the HMO’s he or she is contracted with.

Deductible
When you or your employer picked your insurance, you decided on the deductible amount. That is the set amount you must pay toward any illness, injury or counseling before your insurance will start to pay its agreed sum. A $500 deductible is what most policies offer. In order to pay lower premiums for a policy, you may agree to have a MUCH HIGHER deductible before the insurance ‘kicks in’, therefore, while you are not covered well for low cost illnesses, etc., you will be covered for major illnesses. Your insurance will not begin to pay for session treatment until your deductible has been met. A telephone call to the number on your insurance card will make that information available to you.

No insurance or “NO” to insurance
HIPAA (Health Insurance Portability and Accountability Act of 1966 Title II) is America’s attempt to protect individuals from being misused, mistreated or misunderstood because of an illness or because of the potential of an illness. No one can share your health record information with anyone without your complete understanding and signature. When working with a therapist you are entitled to ‘privilege’ whereby everything discussed in counseling is private and is protected under the law. The only ‘however’ to that is the privacy of privilege is only as good as YOU keep it. As far as we can tell at this time, under HIPAA, any diagnostic info given to an insurance company to justify our claim for service is unbelievably well protected.

The HR person at your work is also obligated to protect happenstance information they may come by, such as; in a small company, when negotiating for next years insurance contracts, HR (or other officers of the company) may be able to deduce which employee is using their insurance a lot. To that end, because you know yourself and your work environment best, some may chose to NOT use insurance for some doctor visits.