Many clients initially want to know if I am a contracted provider with their insurance company.   The following is a list of Insurance Companies, Managed Care Organizations (MCO’s), Preferred Provider Organizations (PPO’s), Health Maintenance Organizations (HMO’s), Employee Assistance Programs (EAP’s) or contracting/credentialing agencies with which I am currently enrolled as a provider.   (Some of the below have plans within plans, and providers are not always matriculated into every plan within any given company.   So, it’s always best to call your insurance company ahead of time, just to make sure.   Scroll down to near bottom of this page for the right questions to ask).

Aetna
Allen Group
Anthem (formerly Blue Cross)(includes Wellpoint)
App-One (formerly Aperture)
APS (formerly HMC Companies)
APS Healthcare  (formerly Shepherd-Pratt EAP)
Beech Street (includes merger with CAPP Care)
Blue Shield (aka USBH in San Diego)
Bradman Network (letter on file at this time because, according to them 
   there is “Not much business in California”)
CAQH
Care First Health Plan
CCN (Coventry and First Health)
Cigna (includes Managed Care Compare aka, MCC, includes People Help)
Ceredian (aka Military One Source)***
CHIPA (College Health IPA)
Claremont Behavioral Services (services “mostly” Northern California  
   clients)
Comprehensive Behavioral Services
CompCare (same company as Comprehensive Behavioral Care)
CONTACT
Coventry (formerly CCN)(Includes First Health Network, First Health and 
   HealthCare Compare, aka, HCC)
CPS (Child Protective Services, now called CWS for Children's Welfare Services).
Creative Care Mgt.
Empathia
Employee Advisory Resource (EAR--covers all USA but “pending” in San
   Diego area)
FedMed (aka, American Mental Health Network--AMHN)
First Access—-Referral and Repricing Network  (formerly Competitive
   Health)
First Choice Health
First Health
Fiserv
Focus (aka, Coventry)
Galaxy Health
GEHA (Government Employee Health Association)
Great West
Harrington Health
Health Comp.
Health Management Systems of America (HMSA)
Health Net (usually uses Managed Health Network)
Healthsmart (formerly Interplan)
Healthy Families (a program that works with other primary insurance companies like Blue Cross, Health net, etc.)
Hoffman La Roche EAP Provider Network
Holman Group
Horizon Health (formerly HHRC, Integrated Insights and includes ACORN
   and ESSCO)
Humana
Integrated Behavioral Health (IBH)
Interface
Karmen
Life Solutions
Lifestyle (formerly CorpHealth--Covers parts of Humana, plus
   TrustMark and Guardian employees)
LifeSync (formerly CorpHealth)
Magellan (aka, MBC, MedCo or MBH--covers some of Aetna and Aetna
   Behavioral Health; Vista, aka, VPPA)
Managed Health Network (MHN--covers Preferred Provider Health
   Network, aka, PPHN)
Matrix Psychological Services
Medi-Cal (Administered by Optum in San Diego County)
Medicare (I currently refer all Medicare clients my officemate. See below.)
MHNet
Military One Source (aka Ceredian)***
Mines and Associates
Multiplan (absorbed PHCS) (covers National Resource Consultants, aka
   NRC)
NEAS (formerly DORRIS, aka Empathia)
Networking Advantage (Workplace Options)
One Health Plan (aka Great West Health)
Optum (formerly United Behavioral Health)
Pacificare (soon to known as United Health Care or UHC)
PMHM (contact is with Behavioral Health Services)
PPO Next (bought and incorporates Preferred Health Network, aka PHN)
Private Healthcare Systems (PHCS) (bought by Multiplan)
PS Health Plan Solutions
PsychCare (includes Life’s Solutions)
Reach
San Diego County (aka Treatment Evaluation Resource Management or
   TERM)
Scripps
Tri-West/Tri-Care (formerly, CHAMPUS, Partners, TriCare may now
   have a Blue Shield component)
Three Rivers Provider Network (TRPN...may be part of Aetna)
UniCare
United Behavioral Health (UBH--Covers Medi-Cal in San Diego, renamed
    “Optum” for Medi-Cal component)
United Health Care (uses UBH providers. Purchased Pacificare)
United States Behavioral Health (USBH, the local Blue Shield contractor)
USA Health Network (Nationwide)
Value Options
Vista (see Magellan)
Wilson Banwell.

***At this time I choose not to work with Medicare, Secure Horizons, Integrated Health Plan or Compsych.  [Dr. Jean Sullivan accepts Medicare and Compsych, and she is glad to talk with you. Her telephone number is: (858) 381-5725]. I'm putting on "Hold" Military One Source (now managed by Value Options in a special program) because of some recent policy changes that negatively affect clients. I no longer conduct Employment Development Dept. (EDD), Social Security Income (SSI) or Workman's Compensation evaluations because of failure-to-pay issues. I also do not take any case that is likely to be involved with courts, nor do I write letters to courts, attorneys, etc. in cases that started out as "regular" cases, but later devolved into court cases.   I’m not a provider with Kaiser, Psychiatric Centers or BHA (Behavioral Health Associates).   These last three use their own, in-house, psychologists and other employees, hence don’t contract with outside providers.

Insurance companies present unique challenges to both clients and providers, alike.   Many companies tell the client one thing and later do something else.   This applies to co-pays, number of authorized visits, billing addresses, etc.   I have found that getting basic information in writing beforehand reduces misunderstandings.   Insurance companies will provide the necessary information needed for you to make an informed decision regarding beginning treatment, but you have to call them.   Before arriving for your first appointment, please call your insurance carrier.   Their toll-free number is usually on the back of your insurance card under something like “Member Services.”  Ask for "Benefits", and then ask them the following questions. I have found that even insurance companies will give you the wrong address for billing, so pay special attention to this one. Bring this information with you the first appointment: (Print this page so you won’t miss anything...)

INSURANCE INFORMATION

Name of Patient/Date of Birth:___________________________/____________

Name of Policy Holder/Date of Birth:______________________/____________

Name of Carrier: _________________________________________________

Type of Product (PPO/HMO/EAP): __________________________________

Member/Policy ID Number: ________________________________________

Group/Plan Number: ______________________________________________

Authorization Number (if needed): ____________________________________

Number of authorized visits: _________________________________________

Beginning and ending dates of authorizations: ____________________________

Deductible amount: _______________________________________________
 
Beginning date for deductible: _______________________________________

Co-pay amount/visit: ______________________________________________

Insurance Co. billing address: _______________________________________

   (This is sometimes the   __________________________________________
   same address as the one
   used for straight        _____________________________________________       
   medical claims listed
   on your card, but often  __________________________________________
   is not.)

Insurance Company Telephone Numbers (for troubleshooting):

Provider ________________________

Member: ________________________

Today's Date _____________________

Additional Notes: 

Psychologists are not allowed admitting privileges at psychiatric hospitals, nor do we usually treat clients at in-patient facilities.  Hence, insurance companies will not cover our services if you are in a psychiatric hospital, with some rare exceptions, e.g., psychological testing.   I do accept clients who are just coming out of psychiatric hospitals, such as Aurora, Palomar, Tri-City, Scripps, MacDonald’s Center and Mesa Vista, to name some.   Additionally, I work with clients who participate in Alcoholic Anonymous (Narcotic Anonymous, Marijuana Anonymous, Sex Addiction Anonymous, Al-Anon or any other “A”-based group).   I also work with clients who are in and out of Residential Treatment Centers (RTC’s or “half-way homes), such as sober living facilities, Project Oz, or are actively working with RTC’s or outpatient treatment programs such as The Neighborhood House, MacAllister Institute, etc.   (For a complete list of my areas of experience and/or expertise, click here.)

ality, couples

therapy, counselor.)

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