Another discussion of attachment (with poll)

It depends on your individual plan. I get like 50 visits a year. Until recently my pdoc had to talk to my ins company (and I do not have a clue what he said) or send in paperwork.. and he would get about 8 visits at a time before needing to do it again for further visits. Now my insurance company has changed providers for my mental health portion of my benefits and there is no preauth needed. I have a PPO plan but I still needed for my MH benefits to have a doc or mh provider that was on a particular list... and luckily with this change my pdoc was on the provider list.

It is basically what your employer has asked for benefits for your individual plan or what you have signed up for ... if an individual plan.

PPO plans generally means no referrals needed for MEDICAL care if you choose someone from your PPO network. Sometimes particular things will need auths...such as MRI's or other things...

I just speak from my personal experience and also part of what I do for a living on a daily basis.

Ipse... I am sorry to hear of your experience and glad that you have persued this and been successful. It is not without battering and being abused in many ways. I have been here in my distant past and I remember that it was horrible and did make me question myself. My pdoc at the time told them that their repeated questioning of my care had served to cause a regression in me.

It really does vary from provider to proviider and situation to situation. I am sorry that you have had to go through this. It was years ago for me but hearing of your experience gives me a terrible deja vu. Yuck.

Secret is right, it is about what the employer wants in their contract. For example, I get 52 sessions per plan year. Ha! I was at 25 when the HMO started their garbage. I had increased to 2x per week and they had a fit. A royal fit and sent me into a tailspin for awhile.

Some of you might remember those posts on here...this new PPO with my husbands employer is supposed to be unlimited outpatient. I won't rejoice just yet. What is unlimited to them? Can I go every day? Ha!!!

Yes, I understand that different people's PPO plans allow for different numbers of visits per year. But if you are within that number, you shouldn't have to justify, right? Sorry I was so confusing.

It depends on the particular PPO plan. Some request info on the sessions to auth them, other plans let patients go without needing auth. Psych requirements often differ from the medical even with PPO. Call the number on the card and ask.

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SecretGarden said:
Perhaps I was too wordy above.

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No, it's just me. I have a hard time understanding this stuff.

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SecretGarden said:
PPO plans generally means no referrals needed for MEDICAL care if you choose someone from your PPO network.

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What is not considered MEDICAL care? Do you mean things like Dental or Vision? (I know my opthamologist makes a big deal about how some of the services he provides to me are MEDICAL and some are VISION.) Do you think mental health visits would not be considered MEDICAL?

ETA: SecretGarden, I see you just edited your post to provide the answer to the question in my second paragraph. Thank you.

Gee Sunrise ...You are quick.. I was just up at 2 something a.m. here...with one eye open not sleepin' so out of bed and you were that quick....but glad you caught my revisions. Any other questions let me know. Good luck.