Quote:
Originally Posted by LonesomeTonight
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?
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Hi LT - I have a employer/employee owned insurance that is managed by a local insurance provider, so nothing that you could have unless you lived in my area and worked for same employer. When I called, I did ask if my call would flag my file for review as I too was worried about that. At first, I felt weird asking that question; but then I figured I'm talking to someone in the MH/Behavioral Health segment and talking about increasing sessions from 2-3x a week. That person probably has had other calls that would seem as paranoid if not more than my call. The assured me that calling would not flag my file. I can't say that will be the same for others.
I have no clue what my T puts down other than adult psychotherapy. When we (T and I) talked about needing to find a medical necessity reason, I got the impression that she would not be able to fully defend the need. I do feel like the 3x a week have been helpful.