If you receive a CSA for an ongoing patient for further treatment, the negotiated price will be based on the patient`s informed agreement and agreement when they begin treatment with you. 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. Outpatient rehabilitation is about home care during the life of the hospital. In some cases, outpatient treatment consists of one-on-one sessions with a certified mental health counsellor, psychologist or psychiatrist. At other times, it may include partial hospitalization, during which the patient spends his days in a treatment centre and returns home at night. Outpatient rehabilitation also includes intensive outpatient treatment in a specialized outpatient rehabilitation centre. 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. This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network.
In this case, the patient usually makes the case with the assurance of an ACS with you before starting treatment. Sometimes an insurance company may have a “payment policy with the highest in network rate,” in which case you will not be able to negotiate the rate. You still have the option to refuse the SCA if the sentence and conditions are not acceptable to you. If the patient has not had the chance to find a sufficiently qualified network provider, then the patient pleads for an SCA with the out-of-network provider before the start of treatment. MANAGED HEALTH NETWORK (MHN) includes Health Net/ Centeneblue SHIELD OF CALIFORNIACALIFORNIA HEALTH AND WELLNESS-MEDI-CAL (also called CENpatico) ANTHEM BLUE CROSS-MEDI-CALWESTERN HEALTH ADVANTAGEMAGELLAN (serves most emperor patients, Kaiser does not allow children to be seen by private community therapists like me). EAP PROGRAMSEMPLOYEE AND FAMILY RELATIONS SUTTER EAP (not Sutter Select) ANTHEM BLUE CROSS EAP (contains Unicare, Wellpoint). OTHER: If you don`t see your health plan above, I recommend you call the behavioral health number on the back of your insurance card.