Here are some very important points concerning mental health care and health care insurance services.
2. Mental health care providers who are billing insurance for treatment(s) are “required” by the insurance carrier to designate a mental health diagnosis (a medically-coded mental health disorder) to the patient’s clinical record. Truly, this information can then be used against the patient in the form of future denied claims or limitations and restrictions in accessing benefits and certain types of health care that they would allow or pay for. This system builds insurance profit.
3. The mental health diagnosis or disorder thus applied to treatment might not be completely accurate or fully relevant to the patient’s actual presenting needs or problems. Many practitioners feel as though they are forced into stretching and modifying assessments and evaluations so that the clinical diagnosis will fit-into the insurance carrier’s specific system of approved and qualified claims and coverage for services.
4. These “stretched” or otherwise “interpretive” diagnostics can cause patients to feel stigmatized, and categorized by a given diagnostic label. A patient may begin to believe that his or her life is more disordered than it really is, and begin to think that without critical treatment, things could remain problematic or get worse. This can create an inflated dependency on treatment and insurance use.
6. Of great importance is confidentiality! Since insurance companies always look for ways to deny claims and limit or otherwise control benefits, they will surely find ways to do it. And since they are paying for at least some of the patient’s treatment, they can access patient records. Here they will scrutinize treatment methods and objectives, question improvements made or not made (all very subjective), and challenge recovery or overall progress. They may ask the practitioner to prove that the prescribed treatment is “medically necessary”. And know this: An average insurance claim may pass-through more than a dozen different people who are trained to “evaluate and challenge” the merit of, or the necessity of the given treatment. This evaluation of the patient’s treatment is equally subjective and is purposely set-up to reject billing reimbursements to the health care providers and coverage for the insurance users.
7. Insurance fine print and hidden provisos within insurance policies are common in insurance plans. Remember, the goal of insurance companies is to collect money, but then not pay much or any of it back out. The “fine print” will contain listed exceptions and disqualifying language which can be difficult to understand.
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