INSURANCE  FREQUENT ASKED QUESTIONS

Does my health insurance cover psychotherapy and psychopharmacological services?  Can I see anyone I choose?   All insurances in Massaschusetts cover mental health treatment and most plans significantly limit your selection of providers.  However, LPA's providers generally are on most of the insurance panels. But it is still your responsibility to check to make sure the person you have chosen to see is covered by your plan.
Do I need pre-authorization for office visits?  HMOs generally require pre-authorization, which you can obtain by calling the toll free number. Once the original authorization  has been used, the therapist is required to submit a form explaining why more sessions are needed.  This requires sharing some confidential  information about your problems and describing the plan for resolving those problems.  PPOs may or may not require pre-authorization. You will need to check.
What if the most important issue for me to keep in mind about insurance coverage?  That it is YOUR responsiblity, not the therapist's, to confirm the nature and extent of your coverage.  While LPA will be helpful with this process, we do not make assumptions about your coverage or take responsibility to confirm the coverage. Keep in mind that you do not automatically receive the full coverage offered by your policy, This only occurs if the insurance company approves requests to use all of your benefits.  One final note. As a subscriber you have the power to appeal decisions if requests for services are rejected.  You also have the power to inform your employer and/or insurer if you are dissatisfied with your mental health coverage.   
Most health insurance policies cover mental health services under guidelines that refer to "medically necessary" services. This typically means coverage for sessions in an office for a diagnosable mental health problem.   The amount of coverage varies according to your policy.  In addition, a managed care company that specializes in mental health benefits may provide the actual coverage.  These "carve-out" means you must check to find out who provides your coverage and what the benefits are.
Are there advantages to paying out-of-pocket (privately)?  Despite the higher cost to you, there are advantages to paying for your own therapy.  Confidentially is a key reason.  Providing the information insurance companies require means data is entered into a national data bank and the informaiton is handled by various insurance company employees.  Also, some insurers attempt to have a more active say in treatment plans. Finally, if you are paying than you can see whomever you want and whatever frequency and your therapist decide is in your best interest.
How do I find out my health insurance information and coverage?  There is usually a toll free number on the back of your insurance card.  Call and obtain the information about your  coverage.
What services are not covered?  Again, this may vary according to your plan but typically such services as court testimony, school visits, telephone and email consultations, and collaboration with other professional are not covered.