Table of Contents INTRODUCTION       1 WHY TAKE INSURANCE?       3 UNDERSTANDING INSURANCE PLANS: DECODING THE ALPHABET SOUP       5 Meet Jack     5 First, A Few Definitions     5 Types of Mental Health Coverage     6 Employee Assistance Program (EAP)     6 Traditional Indemnity/Fee-for-Service Plan     6 Managed Care Plans     6 Health Maintenance Organization (HMO)     7 Preferred Provider Organization (PPO)     7 Exclusive Provider Organization (EPO)     7 Point-of-Service Plan (POS)     7 A Comparison of Typical Insurance Plans     8 Getting Involved: Making Choices That Fit Your Practice     9 If You Are a Network (or Panel) Provider     9 If You Are an Out-of-Network Provider     9 A Tale of Two Therapists: Different Levels of Provider Participation     10 A New Kind of Health Plan: Tax-Advantaged Savings Accounts     11 Health Savings Accounts (HSA) or Medical Savings Accounts (MSA)     11 Health Reimbursement Arrangements (HRA)     11 Flexible Spending Accounts (FSA)     11 EMPLOYEE ASSISTANCE PROGRAMS: A CLOSER LOOK     13 Questions and Answers     14 HORROR STORIES: MYTH OR REALITY?     19 If I Take Insurance, I Have to Do Billing and Lots of Paperwork     19 If I Take Insurance, I Have to Discount my Fee     19 If I Take Insurance, I Have to Do Brief Therapy, and Sessions Will be Limited     19 If I Take Insurance, My Therapy Will be Micromanaged by Idiots at the Insurance Companies     20 All the Networks are Full     20 If I Take Insurance, My Clients Will Have to Get a Doctor Referral     20 If I Take Insurance, I'll Have to Give Diagnoses to Clients Who Aren't Mentally Ill     20 If I Take Insurance, I Have to Deal with HIPAA     20 BECOMING A NETWORK PROVIDER: SELLING YOURSELF TO INSURANCE COMPANIES     21 Your Letter of Interest     22 Panel Applications     23 Another Entry Point: Ad hoc, Temporary, or Single-Case Status     24 Questions and Answers     25 TALKING TO THE INSURANCE COMPANY: WHO TO TALK TO, HOW TO GET THROUGH     27 Administrative Staff     27 Clinical Staff     27 Navigating the Automated Phone Maze     28 PARITY LAWS AND HIPAA: LAWS YOU NEED TO KNOW ABOUT     31 Parity Laws     31 HIPAA (The Health Insurance Portability and Accountability Act)     33 STARTING THERAPY: CHECKING COVERAGE AND INTAKE SESSIONS     37 First Contact     37 Reasons to Call the Insurance Plan — Now!     38 Checking Benefits     39 Checking Coverage Form     41 Translating "Insurance-Speak"     42 Care Denials: Bad News Before Treatment Begins     43 The First Session     44 Reasons for a Treatment Agreement     44 The Insurance Card — And Why You Shouldn't Trust It     45 GETTING MORE SESSIONS: AUTHORIZATION REQUESTS     47 What Case Managers Look for: "Medical Necessity"     48 Writing a Treatment Update     49 Authorization Requests: Dos and Don'ts     50 Why Your Request Might Get a Closer Look     52 Retro-Authorizations and Extensions     53 ONGOING THERAPY     55 Losing Coverage     56 Questions and Answers     57 GETTING PAID: SUBMITTING CLAIMS     59 As a Participating Provider     59 If You Were an Out-of-Network Provider     59 The Revised CMS-1500 Claim Form (formerly the HCFA-1500)     60 A Sample CMS-1500     61 How to Complete the CMS-1500 Claim Form     62 Questions and Answers     67 THE CHECK ARRIVES — OR DOESN'T: THE EXPLANATION OF BENEFITS AND CLAIM DENIALS     71 A Sample Explanation of Benefits (EOB)     71 Understanding the EOB     72 What to Do When You Get the EOB     72 Questions and Answers     73 Why Your Claim Might be Denied     74 What to Do if You Are Denied     76 APPEALS: FIGHTING DENIALS     77 The 10 Rules of Successful Telephone Appeals     77 Steps to Appealing a Denial     78 Specific Appeal Situations     80 Questions and Answers     81 ELECTRONIC BILLING — WITH OR WITHOUT A COMPUTER     83 Electronic Billing     84 Submit Directly to the Insurance Company     84 Submit Through a Claims Clearinghouse     84 Submit Through a Billing Service     84 What's In It For Therapists?     84 Questions and Answers     85 CLINICAL ISSUES AND CONFIDENTIALITY     87 Clinical Issues     87 Confidentiality Issues     88 COMMON TYPES OF INSURANCE FRAUD: 11 EASY WAYS TO JEOPARDIZE YOUR LICENSE     91 SPECIAL ISSUES: COUPLES, FAMILIES, AND "DOUBLE COVERAGE"     95 Couples or Family Therapy     95 "Double Coverage:" When A Client is Covered by Two Insurance Plans     96 Questions and Answers     98 LIFE AS A NETWORK PROVIDER     101 What's Expected of You     101 Provider-Profiling     102 Audits and Site Visits     103 Controlling the Flow of Clients     104 If You'd Like More Referrals     104 If You'd Like to Halt the Flow     105 IS TAKING INSURANCE RIGHT FOR YOU?     107 A Self-Quiz     107 Taking Care of Yourself: The Secrets of Managed Care Sanity     108 A Final Question     110 ENDNOTES     111 APPENDIX A: STATE INSURANCE DEPARTMENTS     113 APPENDIX B: RESOURCES     117 APPENDIX C: PARITY LAWS AS OF JULY 2006     121 APPENDIX D: GLOSSARY     123 APPENDIX E: SELF-PAY AGREEMENT     129 INDEX     131 TO ORDER NOW, CLICK HERE TO RECEIVE BARBARA'S FREE MONTHLY INSURANCE E-MAIL NEWSLETTER, CLICK HERE (Your information will remain confidential.)