Linden BP is a fee-for-service based practice, meaning that patients are responsible for payment at the time of service. Our goal is to help each individual/family make the most informed decision before submitting a psychological (also known as a “behavioral health”) claim to their medical insurance. We appreciate that psychological services are costly and that it seems desirable to utilize medical insurance benefits to cover these services. Several years ago, our team of doctors chose to pull off of insurance panels in order to have clinical judgment guide decision-making, rather than regulations/criteria set by the insurance companies. This means that our doctors are considered “out-of-network” by all insurance companies. While we are happy to provide the documentation necessary to assist with submitting a claim to your insurance company, we do not manage insurance claims directly.
Before you choose to submit an insurance claim, there is some important information for you to consider.
• All insurers REQUIRE a formal diagnosis on any claim they process. This means that that in order for a claim to be considered for reimbursement, a diagnosis of a “mental health disorder” must be given. Certain diagnoses are typically not reimbursable which can further complicate billing.
• Managed health care plans (HMO’s and PPO’s) may require pre-authorization for mental health services in order for a consumer to be eligible for reimbursement. These plans often have a limited number of sessions available each year.
• Insurance carriers routinely request information about diagnoses, treatment plan/progress, clinical summaries, and at times copies of the clinical record, significantly limiting confidentiality. This information becomes part of the insurance company files and is typically stored in a larger database and/or even shared with a national health information data bank. While information is reportedly kept confidential, it is important to understand that it is no longer within the control of our team once it has been submitted to the insurance company.
• In our current health care system, diagnosed conditions (even psychological) become “pre-existing conditions” and can impact future applications for medical, life, or disability insurance. Insurance companies routinely check with medical information data banks when evaluating an applicant. Previous diagnoses of mental health conditions may impact determining acceptance and rate.
• Choosing to stay “in-network” can be limiting in that as a consumer there is some loss of control over options of providers and treatment decisions. Rather than decisions around clinical care being led by the psychologist and the individual or child and family, these decisions are determined by what is allowed by the insurance plan.
• Some providers who are in-network get used to being able to see patients on a weekly basis for extended periods of time. As a fee-for-service practice, we fully value the commitment our families make to get to appointments and work hard to build the skills necessary to lead to improvement.
We hope this information is helpful. Please let us know if you have additional questions that we can answer in regards to insurance submission. It is our desire to provide exceptional care and service, including when it comes to assisting with insurance. What we cannot guarantee, is that insurance companies will also do the same!