Carefully Consider Why YOU MIGHT NOT WANT to Use Insurance:
Today’s insurance market is a complex place to do business, whether you are a carrier, a provider like HealingKC, or a beneficiary, like you. Historically in Kansas, insurance carriers were regulated closely by a powerful insurance commissioner who took seriously consumer protection and advocacy.
As the political winds have shifted, consumers look closely at their insurance benefits, particularly when used in the highly sensitive area of psychotherapy and/or relationship counseling- including sex therapies.
Critically Important Information: (Marital) Therapy, Diagnosis, and Health Insurance Reimbursement:
There is a long-running issue with the validity of insurance reimbursement for relationship or sex therapy. Please review this section carefully if you are seeking these services. Insurance companies will NOT reimburse psychological service providers for diagnostic codes dealing with relationship or sexual problems because these are not seen as “medically necessary.” Counseling services specifically for couples counseling or sex therapy where no mental illness has been previously diagnosed by a qualified physician or sex therapy must be paid in cash.
What is NOT covered by insurance is any therapy intended only to address problems in a relationship or any problem that is primarily sexual in nature.
If this is your goal in seeking treatment, our staff can provide those services, but only by out-of-pocket payment. This is also true of divorce therapy that is not responding to a specific mental health concern. Many times children and adults are having significant mental health problems adjusting to the divorce. Those are reimbursable by insurance because it can be shown to be a “medical necessity.” However, co-parenting therapy, supervised therapy with parent and child to reintegrate their relationship, and any forensic service related to divorce is NOT reimbursable by current law.
To be clear, this is not a policy of HealingKC, but a requirement under all insurance company contracts. Any provider who is billing for a marital-only or sex therapy (as opposed to conjoint services for an identified and properly diagnosed client) is doing so in violation of his or her contract with their insurance carrier, potentially committing insurance fraud and subject to recoupment. Please feel free to contact our office for more details on why our services would not be billable through insurance.
Example of how Major Insurance Companies disclose your confidential mental health records.
Blue Cross Blue Shield of Kansas and Medical Records Auditing: The largest insurer in Kansas, Topeka-based Blue Cross and Blue Shield of Kansas requires full access to members Protected Health Information (PHI) record in order to determine “medical necessity” for treatment. This means that your psychiatric records may be turned over to a company called Verisk for review and auditing. While BCBS follows HIPAA requirements in exempting the “psychotherapy note,” which contains the most private process notes from your psychotherapy, a great deal of information exists there that is required to define medical necessity. It is likely that the insurance carrier, its sub-corporation New Directions or Verisk will require more information about your case than you feel comfortable revealing. While BCBS of Kansas holds that this is not a change of policy and all members were signed on to it, the implementation prior to January 1, 2016, required only a routine treatment plan be submitted with goals and objectives. That is no longer their stated policy. FPS has responded to this more extensive auditing procedure by making adjustments to our electronic medical record to both meet the requirements of BCBS and to protect sensitive patient data. However, since we were not apprised of this until October 2015 and BCBS was at one point retroactively auditing records, we cannot assure that your records are protected as psychotherapy notes from that period nor even that they would be in the future.
According to the BCBS KS website, if you have a complaint or are dissatisfied with a denial of coverage for claims under your BCBS Kansas plan, you may be able to appeal or file a grievance. Contact BCBS Customer Service at 1-800-432-3990 or visit www.bcbsks.com/blueaccess, or the Kansas Insurance Department, 420 SW 9th Street, Topeka, Kansas 66612-1678, Phone: 800-432-2484, or visit www.ksinsurance.org, or the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa.
- The security (or not) of your confidential medical records: All insurance companies are bound by federal HIPAA laws to protect your health records from improper release. However, a December 17 2015 news story on NPR found that “Millions of private medical records have been hacked at large insurance companies like Anthem,” a company which owns many of the BCBS companies around the United States (but does not own BCBS of Kansas or Kansas City).
If involved with this system HealingKC could not be responsible for any information once it is released to any insurance company or any use to which that company might submit it. We encourage you to learn more about your insurance company’s policies on these matters, by contacting them directly.