As a psychotherapist in private practice, I decided not to be part of an insurance panel. My patients pay me directly for out of-pocket services. I provide patients with a super-bill (a statement listing data, service codes and payments) that they submit to their insurance company for a-network benefits for reimbursement. Most of these plans have a high franchise rate before all a-network services take effect. An SCA should in principle meet the individual needs of the patient and the cost benefit for the patient`s insurance company that sees you, not on an in-network provider. Here are some of the conditions that must be met for an ACS to be granted: If you receive an CAS for a patient in progress for further treatment, the negotiated rate is based on informed consent and patient consent when you begin treatment. Rate increases are consistent with your pricing policy in informed consent. You cannot charge the patient a lower horizontal rate out of your pocket and then charge the insurance company your full normal rate if the CAS has been dated in the past to cover the meetings. If the patient has recently switched insurance providers, the insurance company may accept a limited number of sessions (approximately 10) and a period (for example. B 60 days since the insurance change) to allow the patient to continue treatment with the current network provider while switching to a network provider.
If there is evidence that the person could pose a danger to himself or others, or if it affects the patient psychologically or mentally (for example. B failures in the progress of therapy), if this proves necessary to switch to an in-network provider, a case could be advanced for an increase in adequacy with the current provider. Examples: a patient has an uncertain bond and finds it very difficult to trust others. The therapeutic relationship already established with the current supplier can be considered as a factor in granting the SCA. It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients.