A Letter from Dr. Richard — “Why I Don’t Bill Insurance Companies”
Dear Potential Patient,
Many times patients ask me to bill their insurance company for my services and feel disappointed when I decline. I explain to them that one of my concerns is that I always act in their best interest. There are some things involved with billing insurance companies that I find ethically questionable so I choose to avoid this practice.
Here’s why:
1. Nearly all health care insurance companies utilize some level of clinical management. If you request that I bill your insurance company, I must provide whatever information regarding your care that is requested by the clinical management personnel. This includes a diagnosis and may include a request for specific information with regard to what you disclose to me during our sessions together. This quite clearly demonstrates a breach of confidentiality and I have an ethical duty to protect your privacy.
Furthermore, insurance companies may use such clinical information to determine your future benefits, which they will allocate at their own discretion. You should also be aware that the FBI and law enforcement officials can access your insurance information at any time. This could be used to your disadvantage should a legal problem arise.
2. Many insurance plans utilize managed care practices in an attempt to keep costs at a minimum. This means getting therapy sessions authorized becomes cumbersome and time consuming. Each plan has different requirements for authorizations, often including many hours of paperwork and phone calls per week for the clinician. Some insurance companies will also deny therapy in favor of patients taking medications, depending on the diagnosis.
Often, the number of sessions allowed per year is limited, or the patient may first need to a referral from their primary care physician. You may be required to go through a preliminary telephone screening interview with the case management personnel for them to determine whether therapy is needed.
Once you’ve been approved, you may have to contact several of their chosen providers to find one who is accepting new patients, is convenient to your location, and has expertise with your concerns. When you find someone who can help you, you may have to wait several weeks due to pre-authorization requirements.
Sometimes you may only be offered one-to-three sessions to begin while the insurance company waits for an assessment and information to be forwarded from your new therapist. Sessions may then be authorized in small numbers, requiring your therapist to disclose an update on your progress before more will be authorized. Some plans may dictate what kind of treatment plan may be used.
3. The third reason I choose not to bill insurance companies for my patients’ care is that many companies will not cover care unless they find it is a “medical necessity.” This may mean the patient may need to exaggerate their symptoms to appear worse than they actually are in order to receive coverage. Many companies do not cover relationship concerns or adjustment difficulties as part of the treatment plan unless they are related to a serious mental disorder or a substance abuse problem.
This creates a negative situation for both patient and therapist. Often the “assessment” sessions allowed are not sufficient for the therapist to give an accurate diagnosis, yet the insurance company will not authorize more sessions until a diagnosis is provided.
This puts the therapist in the position of having to “guess” at a diagnosis, which is not in the patient’s best interest. This, then, creates a history that is inaccurate and possibly untrue. Most importantly, a patient should not be given a mental illness diagnosis that is inaccurate simply to get treatment paid for by the insurance company.
My philosophy of treatment is to discover the wellness that each of us carries within. That which receives our focus, grows. Insurance companies force the focus on illness, which goes against my wellness goals for my patients. My commitment is to always do what is in the best interest of those who seek my help. Doing anything that threatens confidentiality is not in the best interest of those I help.
If a patient wishes to bill his or her insurance company for reimbursement, I am happy to provide a statement including a diagnostic code. My office policy is that payment is due at each session. I accept payment by cash, check or Visa/MasterCard.
I hope to hear from you soon. Thank you.
Sincerely,
Dr. Jacqueline Richard
