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Old Jun 24, 2018, 05:59 PM
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LonesomeTonight LonesomeTonight is online now
Always in This Twilight
 
Member Since: Feb 2015
Location: US
Posts: 22,051
Quote:
Originally Posted by Elio View Post
Like I posted on the other thread, I recently moved to 3 x a week. Right now my insurance covers it. I talked with them and they do random audits as well as if there is a huge spike in claims. During an audit, my T will have to justify medical necessary. I did 2 x wk for just over a year before moving to 3 x wk. So, hoping that is not a huge spike to them. My T keeps saying that we'll work something out if there becomes a problem with insurance. She has also indicated that she charges less for out of pocket than she does insurance. I would not be able to afford to see her this frequently if I was paying out of pocket.

As far as schedule, I see her at different times on the different days, all in the afternoon to early evening. I am lucky that my job allows me to float my hours as long as I am "available" between 9-3pm, so I work an early morning shift. I like not having to go to work afterwards. T did say that it is common for people that go 4+ times a week to not have such a problem after session because of knowing they just have to make it to the next day - makes it easier to set it aside. There is the possibility that in the fall I will move to early morning appointments.

I know some T's work weekends and others work late evenings. My couple's counselor worked 6pm-10pm 3 nights a week.

Can I ask--you can PM me--what insurance you have? I'm worried about mine continuing to cover twice a week (it's out of network, so they only pay 60%). I'm just worried about the audit and that they will decide to deny paying sessions I've already attended. (I have to pay T up front, then submit to them for reimbursement.) They've been behind in compensating, but it's been for stupid reasons, like someone put in the date as the previous year for a session (when I wasn't even seeing this T!), issues with reading the PDFs, etc. I keep having this paranoia that they will say they can't cover twice a week and won't cover the past 5 months or something. But I also don't want to ask for fear it will trigger an audit. Also wondering if it would help for T to list something besides Major Depressive Disorder as the reason code, like maybe if he listed 2 or 3 things (he's confirmed I have generalized anxiety plus OCD), they'd be more willing to pay?