About insurance coverage for evaluation, consultation and treatment in our office
TYPES OF FUNDING:
1) PIP (Personal injury protection) through automobile insurance
2) Health Insurance, including Medicare
3) Other, including state agencies and private payment
1) Auto accident related coverage (PIP)
If you were injured in an auto accident, clinical services provided here should be covered by your PIP (auto injury protection) insurance. (One exception is if, when you last renewed your auto insurance, you opted for the cost saving option to have your health insurance be the primary funder of accident-related treatment.)
You may also have a deductible and/or a per-visit copayment, both of which are also options that slightly reduce your annual auto insurance premiums. Many if not most PIP plans are now managed also--either in terms of needing a precertification after an initial visit OR having preferred provider networks!
PLEASE NOTE: We will be glad to work with you to understand these problems; we will be glad to work with your insurance company to complete forms to justify/explain our services, in order to obtain precertification.
BUT as you are, we are to some degree, at the mercy of the insurance plans; some are difficult to deal with, and we can't always help prevent problems, though we will tell you when we think there are problems, and try to help you overcome them, so we can work with you!
2) Health care and managed health care
If your current problems were the result of another health issue (ie, stroke, aneurysm, etc.), your health care coverage will be primary...and, as you know, most current health plans are managed, and require precertification (in addition to a 'referral' from your primary care doctor...)
Problems to be aware of with some current forms of 'managed care' Health Insurance:
More of our referred patients are experiencing frustrating problems in obtaining authorization for Neuropsychological testing and psychological treatment and therapy
For the past several years, we have been experiencing increasing difficulty obtaining precertification and coverage for our patients. This is due to a number of reasons:
Cost cutting by insurers (particularly the for-profit insurers) leads them to redefine their criteria for authorizations
Increased management by Insurers and employers to control costs--but this has led to increased interference in treatment
- In some cases, patients have been called by their insurer and being encouraged to change psychologists or other providers--to "extend their services." This is insurance-speak for saving the insurers money!
Please go to this link for a report from the online news site, Huffington Post, about these problems--an interview with a patient denied services and several NJ psychologists:
http://www.huffingtonpost.com/2009/10/21/insurance-companies-rape-_n_328708.html
HEADS UP: Common managed care restrictions...
What the insurance companies do not tell you, often, is the restrictions and limitations for Neuropsychological or Psychological consultation and treatment...for example:
By all means, it's always worth it to ask--but the unfortunate fact is that this evaluation is virtually never covered unless there's a medical reason for it (see above).
So, the bottom line (that is, the insurer's bottom line) is often in conflict with our health care needs.
AND this has become a reason why many psychologists, medical doctors and other providers have had to stop participating in some managed health insurance plans--due to not being paid at all or in the correct amounts; great difficulty and too much time (as in hours and hours) on hold or getting inconsistent information from insurers is the reason for this, without results.
Recently, Dr Mangel has had to resign from one such plan, Magellan Behavioral Health; there will be, we are told, a 12 month transition period, during which time current patients can continue to be seen. However, Magellan may refuse to allow new patients to begin treatment.
After a year, we are told that you may be able to return if you have out of network coverage in your health plan. We will have more information about this when avaiable.
It is with much regret and after delaying for years in the hope that things would improve, that this action was taken. But in too many cases, it became clear that this insurer was not willing to cooperate and work with us in a cooperative manner, in terms of authorizing services or paying fairly for services that were pre-certified.
It is also unfortunate that the end result is that, if you are under a Magellan plan, I may not be able to treat you and have it be covered by Magellan and Horizon (Magellan has a subcontract with Horizon to cover what is called 'mental health' coverage).
This is not a decision taken lightly; it only comes after many, many frustrating discussions with this company for refusal to precertify; refusal to pay for precertified service and other reasons.
We will have more to come about this; in the meantime, please ask for details and to discuss this information.
Dr Howard Mangel
August 11, 2009