Helpful Hints To Determine Your Mental Health Insurance Coverage (And Some Little Known Alternative Methods Of Reducing The Cost Of Psychological Services)

The following information will help you follow through with checking your insurance coverage for Outpatient Mental Health benefits. Both Dr. Schmitt and Dr. McKay are participating Blue Cross/Blue Shield of Michigan and Medicare Part B providers. This means we bill them directly and accept their fees. We also accept any other insurance and will bill them directly from our office. We accept Priority Health clients with a Point of Service option (it will say POS in the upper right corner of your insurance card) and many other HMD's, PPO's, MCO's who allow a Point of Service option or allow you to choose out of panel of providers. We often offer reduced fees to those unable to use their HMO coverage due. to various restrictions. We do not directly participate in any HMO's because we have found that we would have to reduce the quality and integrity of the services we offer if we did. This has allowed us to make treatment decisions which are not affected by an HMO's need to improve their profits. Instead, we believe we can provide the highest quality service by charging fair professional fees, billing all insurance companies directly, and offering several payment and financing options. Most of our patients (even those with HMO's) find that 30 to 80 percent of the cost of services are covered by the use of a combination of 1) insurance reimbursement, 2) medical savings accounts, 3) extended payment plans, or 4) reduced fee levels. Please feel free to discuss His with us at the time of your first appointment. By asking for the following information from your insurance company, you will be in a better position to assess the extent of your coverage.

1. How much coverage (in dollar amount number of sessions) do you have remaining on your _ OUTPATIENT MENTAL HEALTH BENEFIT for this year?
$____ or____ sessions Also, what is your LIFE-TIME BENEFIT for OUTPATIENT MENTAL HEALTH? $_______

2. Do you have a DEDUCTIBLE (that is, how much does your insurance company require you to pay before they begin to pay on your bill)?
No _____ Yes _____ If yes, fill in the $____________ amount. (Usually $50 - $250 and all medical care received in any year is credited towards this.)

3. Do you have a CO-PAYMENT or CO-PAY (that is, do you pay a certain dollar amount or percentage of the fee for each service or session)?
No _ ____ Yes _____ If yes, fill in the $___________ amount or the % __________ per session.

4. Has your insurance company established a maximum fee per hour session that they will reimburse for?
No_____Yes_____ If yes, fill in the $___________ amount

5. Does your insurance coverage include psychological testing if that were to be recommended for you?
No______ Yes______ If yes, fill in the $ ___________ amount per hour of testing.

6. What type of mental health therapist does your insurance company recognize? (Some companies or HMO's have discriminatory clauses which arbitrarily pay for the services of only certain practitioners). Circle those below which apply.

a. Clinical (Certified) Social Worker, C.S.W.

b. Masters of Social Work, M.S.W.

c. Masters Degree Psychologist, M.A. (also Limited Licensed Psychologist)

d. Doctoral Degree Psychologist, Ph.D., or Psy.D. (also Full Licensed Psychologist)

e. Psychiatrist, M.D.

f. Physician, M.D.

7. Are there any other restrictions or conditions which your insurance company places on obtaining outpatient mental health benefits? For example, are you penalized, by decreased coverage, if you choose your own provider, or if your provider is not on your HMO's panel?

8. Does your employer offer a Medical Savings Account (MSA), also called "IRS Section 129 Plan"? If so, you may be able to reduce your out of pocket costs by an additional 25 percent by utilizing it. Here's how you can get a 25 percent reduction in the cost of treatment, on as much as $2,500 worth of care (equivalent to an annual savings of as much as $625). This is done by using pre-tax dollars to pay for therapy.

Print this form and bring it to your first appointment or call us if you have any questions at (616) 457-0016.

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