TABLE OF CONTENTS
“Navigating the Insurance Maze, The Therapist’s
Complete Guide To Working With Insurance”
by Barbara Griswold, LMFT
- WHY TAKE INSURANCE?
- UNDERSTANDING INSURANCE
- Deductibles, Copayments, Co-insurance, Provider Networks / Panels
- Employee Assistance Program (EAP), Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Point-of-Service Plan (POS)
- A Comparison of Plans
- Making Choices That Fit Your Practice
- Health Savings Accounts (HSA), Medical Savings Accounts (MSA) ,Health Reimbursement Arrangements (HRA) and Flexible Spending Accounts (FSA)
- EMPLOYEE ASSISTANCE PROGRAMS: A CLOSER LOOK
- MYTH OR REALITY?
- If I Take Insurance,…
- I’ll Have to Do Billing and Lots of Paperwork?
- I’ll Have to Discount my Fee?
- Sessions Will be Limited?
- My Therapy Will be Micromanaged by Idiots?
- All the Networks are Full?
- Clients Will Have to Get a Doctor Referral?
- I Have to Give Diagnoses to Clients?
- I’ll Have to Deal with HIPAA?
- If I Take Insurance,…
- BECOMING A NETWORK PROVIDER: SELLING YOURSELF TO INSURANCE COMPANIES
- Why You Should Have a “Managed Care Resume”
- Your Letter of Interest
- Single case and Transition-of-Care Agreements
- Most Frequent Fees Paid for Therapy
- TALKING TO THE INSURANCE COMPANY: WHO TO TALK TO, HOW TO GET THROUGH
- Navigating the Automated Phone System
- PARITY, HIPAA, AND HEALTH CARE REFORM: LEGAL JUNK YOU NEED TO KNOW
- Parity Laws
- HIPAA : The Health Insurance Portability and Accountability Act
- Health Care Reform: The Affordable Care Act (ACA)
- STARTING THERAPY: CHECKING COVERAGE AND INTAKE SESSIONS
- First Contact: Why You Should Call the Insurance Plan – Now
- Checking Coverage: 13 Essential Questions – A Worksheet
- Translating “Insurance-Speak”
- Care Denials: Bad News Before Treatment Begins
- The First Session
- Reasons for a Treatment Agreement
- The Insurance Card – And Why You Shouldn’t Trust It
- The Perils of Private Pay: When A Client Doesn’t Tell You About Coverage
- GETTING MORE SESSIONS: AUTHORIZATIONS AND MEDICAL NECESSITY
- What Case Managers Look For: “Medical Necessity”
- A Sample Treatment Update
- Authorization Requests: Dos and Don’ts
- Why Your Request Might Get a Closer Look
- Retro-Authorizations and Extensions
- ONGOING THERAPY
- Losing Coverage
- GETTING PAID: SUBMITTING CLAIMS AND INVOICES
- If You Are a Network Provider
- If You Are an Out-of-Network Provider
- Line by Line Instructions to The CMS-1500 Claim Form and Sample Form
- Claims Tips
- THE CHECK ARRIVES – OR DOESN’T: THE EXPLANATION OF BENEFITS AND DENIALS
- A Sample Explanation of Benefits (EOB)
- Understanding the EOB, and What to Do When You Get it
- Why Your Claim Might be Denied
- APPEALS: FIGHTING DENIALS
- The 10 Rules of Successful Telephone Appeals
- Steps to Appealing a Denial and Specific Appeal Situations
- Sample Appeal Letter
- ELECTRONIC BILLING – WITH OR WITHOUT A COMPUTER
- Submit Directly at the Insurance Plan’s Website
- Submit Through a Claims Clearinghouse with a Billing Program
- Submit Through a Claims Clearinghouse Without a Program
- Submit Through a Billing Service
- What’s In It For Therapists?
- CLINICAL ISSUES AND CONFIDENTIALITY
- 13 EASY WAYS TO JEOPARDIZE YOUR LICENSE: COMMON TYPES OF FRAUD
- COUPLES, FAMILIES, AND “DOUBLE COVERAGE”
- Couples or Family Therapy
- Double Coverage: When A Client or Couple is Covered by Two Plans
- Primary and Secondary Insurance: A Chart
- LIFE AS A NETWORK PROVIDER
- What’s Expected
- Audits and Site Visits
- If You’d Like More Clients – or Less
- SHOULD I ACCEPT INSURANCE?
- A Self-Quiz
- Taking Care of Yourself: The Secrets of Sanity
- Getting a Raise
APPENDIX A: STATE INSURANCE DEPARTMENTS
APPENDIX B: RESOURCE LIST
APPENDIX C: GLOSSARY
APPENDIX D: SAMPLE TREATMENT AGREEMENT
APPENDIX E: SAMPLE INVOICE/SUPERBILL
APPENDIX F: SAMPLE SESSION TRACKER
APPENDIX G: SAMPLE PRIVATE-PAY AGREEMENT
TO ORDER NOW, CLICK HERE