[ariatboot]

My insurance company has a thing where after 20 therapy sessions my T has to fill out a treatment plan so they can determine whether they will continue to pay for my sessions or say I don't need them any more. I am extremely anxious about this. I am not ready to be done with therapy and my T agrees but what will I do if my insurance company decides I don't need it anymore? I don't think I can cope with that right now. I have been in therapy for the last 3 years, on and off and the prospect of it being completely terminated by my insurance company (people who have no clue who I am or what I'm going through) is completely terrifying to me. How am I suppose to cope if my therapy is stopped abruptly? Has this happened to anyone else?

[geez]

ariatboot it is to my understanding if a T says you need to continue treatment then that should be good enough for the insurance company. I would try to not worry (easier said than done) and keep us posted on how things develop. When is this going to effect you? Have you thought about a back up plan just in case.

I know my T has said that the insurance company requires something from her about treatment but it doesn't have specifics as far as details I've shared with T. T writes what she has/needs to as to why I need treatment to insure that I can continue with therapy.

Hope you find the answer you are seeking and wishing you peace of mind.

[ladyjrnlist]

If your T fills out the treatment plan, the insurance will continue to pay. I had it happen to me too.

[rainbow8]

In October my T scared me by telling me that my insurance said that my 20 visits were up and I couldn't have more until January. That was incorrect. They needed her to fill out a form as to why I needed more sessions. She did it, and they gave me 20 more sessions. Apparently this is the way it works, and almost always 20 more sessions are granted.

It IS scary, though. I was petrifed!! Don't worry too much because insurance--is it Blue Cross?--just does it that way.

[Omers]

My understanding is also that they go by what your T says. Many T's will also work with you to not stop abruptly. Does your T have a sliding scale?

[seventyeight]

quick question: did you have to have the treatment plan beforehand? a friend of mine wants to know if this is the case. her sessions "ran out," but she didn't realize and continued to go. now, the insurance company said she's out of sessions. if she gets approval for 20 more, do you know if it's retroactive?

thanks for any info. (and she happens to have blue cross.)

[SenatorPenguin8081]

Originally Posted by ariatboot

My insurance company has a thing where after 20 therapy sessions my T has to fill out a treatment plan so they can determine whether they will continue to pay for my sessions or say I don't need them any more. I am extremely anxious about this. I am not ready to be done with therapy and my T agrees but what will I do if my insurance company decides I don't need it anymore? I don't think I can cope with that right now. I have been in therapy for the last 3 years, on and off and the prospect of it being completely terminated by my insurance company (people who have no clue who I am or what I'm going through) is completely terrifying to me. How am I suppose to cope if my therapy is stopped abruptly? Has this happened to anyone else?

I find insurance companies abhorrent, and whenever possible I seek to pay out of pocket.

Really, who is an insurance company to tell the clinical, educated, board certified therapist what is NEEDED or NECESSARY anyway? Insurance companies are all money making schemes. Just like hospitals, offices... all about money, not health. Good money buys good healthcare... blaghokay I'm getting paranoid now I'll stop.

I think you should speak with your T about this. I think he would be the best one to discuss options with and can provide support.

And I have had my insurance terminated before when I lost my job. I had to pay out of pocket after that or go without because I wasn't willing to change T's. My T did charge for a 45 min session though even though I have 90 min sessions. Your T is probably accommodating too?

[SenatorPenguin8081]

Originally Posted by rainbow8

In October my T scared me by telling me that my insurance said that my 20 visits were up and I couldn't have more until January. That was incorrect. They needed her to fill out a form as to why I needed more sessions. She did it, and they gave me 20 more sessions. Apparently this is the way it works, and almost always 20 more sessions are granted.

It IS scary, though. I was petrifed!! Don't worry too much because insurance--is it Blue Cross?--just does it that way.

I think you are right. We never discussed it, but I saw my T for two years and I know I had a cap visit for the year I went over. I think healthcare laws have changed or are changing somewhat to provide equal healthcare for mental health...

[WePow]

My insurace approved 10 at a time this year. I had to have many approvals because I was in trauma therapy this year. My T had to call and fight for me one time because they were not going to approve it - and I will never forget hearing him stand up for me on the phone that way! It was like I finally had someone on MY side!!!!!

Just now they approved only 5 more for the rest of the year - and I already used 3 of them. But it is OK. I know that if something did happen before Jan, my T is already in my corner.

So there are ways for Ts to make sure the insurance company knows they need to approve more sessions.

[WikidPissah]

The insurance companies have to weed out fraudulent claims....so they limit the number of sessions they give to keep a close eye on how many are actually needed. Believe it or not, there are many out there abusing the system, and actually making up fake sessions to get the claim money. I know it's a real pain in the a__, but they need to have some control in place. It depends on your insurance company, but most of the larger ones will continue to offer more sessions as long as your T fills the paperwork out regularly.

One big tip: make sure you read every insurance statement that comes in. Those of us in weekly sessions get them a lot, and you kind of get sick of reading them and just start tossing them into a pile. It is really important that you read every one to keep an eye on the claims and make sure no one is using your id number to get care.

[with or without you]

this happened to me a bunch of times. My T just allowed me to keep paying the co-pay and she would write off the rest on her taxes. I asked her repeatedly if she was sure about this. She told me she wouldn't do it if she didn't want to. She's awesome