A PSYCHOLOGICAL CORPORATION
PSY 8534

 
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INSURANCE INFORMATION

 

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 view the right questions to ask). More and more companies are offering tele-counseling (video or telephonic). I'm matriculating into all of them as they become available. These are listed below and noted accordingly:

Aetna
Allen Group
American Behavioral
Ameriplan (pending)
Anthem (formerly Blue Cross, includes Wellpoint)
App-One (formerly Aperture)
APS (now under HMC Companies)
APS Healthcare  (formerly Shepherd-Pratt EAP, now HMC)
Beacon (Taking over parts of Value Options)
Beech Street (includes merger with CAPP Care)
Blue Shield (aka MBC/HAI in San Diego)
Bradman Network (letter on file at this time because, according to them 
   there is “Not much business in California”)
CAQH (Provider credentialing service)
Care First Health Plan
CCN (Coventry and First Health)
Ceredian
CHIPA (College Health IPA)
Cigna
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)
Creative Care Mgt.
EAP Consultants, Inc.
Emblem Health Care
Empathia
Employee Advisory Resource (EAR--covers all USA but “pending” in San
   Diego area)
Employee and Family Resources (EAP)
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, possibly known as ACCEL)
Healthy Families (a program that works with other primary insurance companies like Blue Cross, Health net, etc.)
HMC Health Works (Application pending)
Hoffman La Roche EAP Provider Network
Holman Group
Human Affairs International (HAI)
Human Management Services

Humana Behavioral Health (Formerly LifeSynch)
Integrated Behavioral Health (IBH)
Interface
Karmen
Life Solutions
Lifestyle (formerly CorpHealth--Covers parts of Humana, plus
   TrustMark and Guardian employees)
Lifesync
Lifeworks
Magellan (aka, MBC, MedCo or MBH--covers some of Aetna and Aetna
   Behavioral Health; Vista, aka, VPPA, also certain Blue Shield contracts through HAI.)
Managed Health Network (MHN--covers Preferred Provider Health
   Network, aka, PPHN)
Matrix Psychological Services
Medi-Cal (Administered by Optum in San Diego County)
Medicare (Some plans...See below.)
MHNet
Military One Source (Now through Value Options/Special Contract)
Mines and Associates
Multiplan (absorbed PHCS) (covers National Resource Consultants, aka
   NRC)
NEAS (formerly DORRIS, aka Empathia)
Networking Advantage (Workplace Options)
New Directions (EAP Network)
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
Prime Health Services, Inc.
PsychCare (includes Life’s Solutions)
Reach
Resources for Living (Aetna's version of an EAP; formerly Horizon Health, before that HHRC. Includes what was Integrated Insights and now includes ACORN and ESSCO)
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 (Soon to be called Beacon)
Vista (see Magellan)
Wilson Banwell.

Online resources:

E-Psychiatry
Healthtap

My Ideal Doctor
(application pending)
Breakthrough (application pending)
Amwell
(Application pending)
Teladoc
(application pending)

At this time I choose not to work with Humana (Medicare component), Integrated Health Plan, or Compsych. Medicare, in general is "OK," but there are many plans that administer Medicare that do not work for lots of reasons; for example Secure Horizonsor Kaiser Advantage, or any "Advantage" plan, potentially. If you have Medicare, I'm willing to help you figure out your coverage and work with you if your plan is provider-friendly.   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 devolve.   I no longer am a TERM provider, having resigned because they are impossible. That means I no longer work with CPS/CWS cases. I’m not a provider with Kaiser, Psychiatric Centers, MHS (Mental Health Systems), Sharp or BHA (Behavioral Health Associates). These last five 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.   Obtaining basic information in writing beforehand reduces misunderstanding. This especially applies to co-pays, number of authorized visits and billing addresses. I have found that even insurance companies will give out the wrong billing address, so pay more attention to this one. 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 on the back of your insurance card under “Member Services.”  Ask for "Benefits", tell them what we are up to and then ask them the following questions. Bring this information with you to the first appointment. I'll do all the billing for you, but you have to provide accurate information. I'll need a separate sheet for each identified patient, or a new sheet for each person in the event of any insurance changes.. (Print this page so you won’t miss anything.)

 


INSURANCE INFORMATION

 

Patient/Date of Birth/Gender:_______________/_________/ M__ F__

Patient's Social Security #: _____________________________________

Policy Holder/Date of Birth:________________/__________/ M__F__

Policy Holder's Social Security #: ________________________________

Name of Carrier: _____________________________________________

Effective (Start) Date: _________________________________________

Type of Product (PPO/HMO/EAP/EPO/POS):____________________

Special Billing codes? (99404 for EAP's) ___________________________

Billing Code Modifiers? (HJ?) ___________________________________

Member/Policy ID Number: ____________________________________

Group/Plan Number: _________________________________________

Authorization Number (if needed): _______________________________

Number of authorized visits (if relevant):___________________________

Beginning/Ending dates of authorizations: ____________/____________

Deductible amount/Deductible beginning date:__________/___________

Co-pay amount/visit: __________________________________________

Insurance Co. billing address: ____________________________________

___________________________________________________________

___________________________________________________________
(This is often wrong, since I am a psychologist and bill under Behavioral, not
Medical services. Even Insurance Co.'s will give you the wrong address, so have
them double check.)

Is there coverage for telecounseling? Videocounseling? Yes___/No___/?___

Insurance Telephone (and other numbers):

For Providers/For Members:__________________/__________________

Insurance Co.'s Electronic Payer ID#:______________________________
(My industry is going electronic, so this number will help me do the
billing for you.)

Insurance Co.'s fax (for submitting billing, if all else fails):

_______________________________

Signature. I certify that the above information has been given to me by my insurance
carrier and is correct.

___________________________________

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 12 Step group). I work equally with non-12 Step oriented clients and programs, such as Smart Recovery and Passages. 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.)