Probably that would be the insurance company. I have been on hold for 10 minutes now, 10 minutes that I could be doing something else productive; 10 minutes that I could be doing some research or treatment planning for you. But no, I have to stay on the phone to beg for 6 or 8 sessions from the insurance company to help you. And this is when you opt to use your out of network benefits, which you pay more for: you have a higher co-payment every session.
The insurance company will do it ‘s best to get information from me to justify your treatment; meaning, they don’t trust the therapist who is sitting right across from you to judge what might help you best. I know this, I worked for CIGNA a number of years ago. I finally got so appalled by what I had to ask, and how I was unable to authorize treatment that I had to leave. And take a pretty big pay cut. That should tell you something. (PS, I have been on hold for 17 that’s SEVENTEEN minutes now).
So here’s the point: Members need to speak up to the insurance companies and to their Human Services Departments. Probably a little more calmly than I did to Rosa, who took my clinical information and was somewhat insulted that I asked what her credentials were. The price of your coverage goes up at whatever rate the insurance companies deem; oh, and your co-pays usually go up as the price of your coverage goes up, and often, covered services decrease.
I heard on NPR a few weeks ago some excerpts from hearing about Blue Cross Blue Shield in CA. I was so shocked that the insurance company representative speaking could report with a straight face that her salary with in the millions, with just her bonuses in the $750,000 range. Is it the actual health care that costs, or the administration of it?
HOW CAN THE INSURANCE COMPANY ASK FOR INFORMATION ABOUT YOUR TREATMENT? ISNT THAT CONFIDENTIAL BETWEEN YOU AND THE PATIENT?
Yes, it is. That is why I am forced to have clients sign a release that they understand I may have to disclose information to the insurance company to
get the treatment covered. I offer minimal information, such as diagnosis, sypmtoms that support the diagnosis and treatment plan. Usually, that works.
Until recently, out of network was not “managed for medical necessity” by Magellan. This is a new tactic to harrass not only the therapists, but the clients, who chose
to pay higher costs to utilitze this benefit.