A way around insurance limits

[Mom2boys]

Just wanted to share this idea with others, in case it may help someone else.

Our insurance covers 30 mental health visits per year. We are almost out of covered visits. I'll be paying 100% of my difficult child's group visits and saving the insurance for the psychiatrist and SW(insurance pays 50%).

I came up with a way around this and our SW is willing to do it. I am going to make an appointment with the SW for me and bring difficult child with me. He won't have difficult child's chart but he's okay with that. Typically our one hour sessions are spent part time with both difficult child and me (about 20 minutes) and the remainder of the time just difficult child. Occassionally, it's just me for a few minutes, too. It all gets billed as "family counseling" so I figured it was worth asking SW if he was willing to do it this way, just to get us through the end of the year. Even with the insurance, I'm still paying about $300 a month!

 

[bigblueagain]

I am assuming that you are paying the SW directly without billing insurance? As most insurances do not cover SW services, even under the auspice of family counselling. You have to have seen a licensed physician in order to have any thing paid. Just an FYI!!!

 

[Mom2boys]

My insurance DOES pay for Social Worker counseling (didn't realize that many don't pay for that - guess I"ve got better insurance than I thought!). Sometimes it's billed as individual, sometimes family (depending upon if difficult child sees him the whole time or if husband or I spend some time there too). The insurance has been paying for visits from difficult child's coverage. Since we are almost out of covered visits but still have a few months left, I"m going to do the appointments under my name so the insurance will be billed from my coverage.

 

[bigblueagain]

welp I won't tell on anyone, but I would caution others not to aggressively pursue this course. It can be construed as fraud, should anyone look into it. Sorry to be so negative, but I feel my roll on here is to try to make sure people don't get into trouble with their benefits. That's why my first question is always, "have you checked with your member or customer service about your benefits, and if you need a referral, always make sure you have it before you go, never expect a doctor's office to get it for you!!!" Good luck.BLUE

 

[Mom2boys]

I'm very sorry if my posts came across the wrong way. I wasn't trying to encourage anyone do something fraudulent.

Our SW is billing counseling sessions as "family counseling" not individual. That's just the way he does it, I did not ask him to do it that way. I guess because he meets with me or husband and difficult child together for at least part of the visit. I'm just trying to get the most out of my insurance. I don't feel like I'm doing anything fraudulent because the counseling is benefiting me too (SW gives me suggestions on how to handle different situations with difficult child) so why can't I get counseling and put it through my insurance?

Again, sorry if my post came across the wrong way. By all means, definitely check with your own insurance to see what limitations or referall requirements apply to your situation.