Insurance companies usually monitor use of the services they insure. Many require you to telephone their offices to preauthorize your appointments...sometimes for a limited number of sessions at a time. Reports from the provider giving your diagnosis and sometimes treatment information to support the diagnosis are requested periodically during the course of therapy. Authorizations for additional sessions are made on the basis of these reports. Providers for their plans have agreed to fee reductions and additional billing paperwork to serve their insured.
To make the managed health care system work for you, note these guidelines:
- Call your insurance company to check whether a preauthorization number is required and the amount of your co-payment to bring with you to your first appointment. (The co-payment for outpatient mental health benefits is often different from the co-payment for visits to your primary care physician.)
- Make your co-payment at the beginning of each session.
- Give 24-hour notice for cancellation of a scheduled appointment. Without this notice, you may be charged for a missed session at full-fee rates because your insurance plan will not pay for missed appointments or late cancellations.
- Charges for claims denied by your managed health care provider are made at full-fee rates unless other arrangements are made in advance.
Please note: The short-term coverage of psychotherapy provided by typical insurance companies is often well suited to its purposes of shorter term goals of eliminating symptoms. However, psychotherapy can also help you maximize your quality of life. It can help you make significant changes in long-standing coping styles that may restrict your effectiveness and satisfaction at work and in relationships. Making such changes may go beyond "symptoms" that insurance companies deem as making psychotherapy "medically necessary." If you decide you want to work on improving your self-awareness, mindfulness, and quality of life, you may want to arrange personal payment arrangements.