I have a question on insurance and PPOs. I have a PPO and they will pay for 20 mental health outpatient visits a year. (They will not pay at all, though, for my current therapist because they don't like his credentials, but that's another story.) Anyway, if you stick within your allowed 20 visits a year, can they still ask questions? I mean, they say they will allow 20 visits, so it should be no questions asked, right? As long as the diagnosis code is one they reimburse for. After 20 visits, you pay yourself. I guess I don't understand how the PPO can be hounding someone (and their therapist) if they are within their 20 (or whatever) allotted visits.

When I did go to see a previous counselor that my insurance would reimburse, I had about 8 visits at the end of one calendar year and about 15 visits the following year before I dropped her. I had no problem getting reimbursement through insurance since I was under 20 visits per year. If I was over 20 visits, I would realize that and not submit to insurance for reimbursement since they wouldn't pay.

I guess I don't understand why a PPO wouldn't pay if you are within your allotted number of visits. Do they monitor consecutive years? Like if you asked for reimbursement for 20 visits, 3 years in a row, maybe they wouldn't like that, even though it is within your allotted number of visits?

Sorry, this is so wordy! I am always interested in understanding insurance, as I like to get every penny I can out of mine.