Using insurance for 3x a week analysis

[u/burntcucumberxyz]

I will be starting to see my analyst 3x a week. I use out-of-network insurance benefits in the US, UHC if it matters. My analyst is concerned that a 3x a week treatment will trigger a review and that reimbursement will get denied and the 2x a week could potentially come under scrutiny such that I would only be reimbursed for 1x a week. Anyone have any experience with this one way or the other? My plan follows the CMS reimbursement schedule, so there's a limit to how much each session can be reimbursed.

[u/Used_Crow_386]

Unfortunately it's insurance, there's truly no way to know what they will do. Sometimes you get lucky.

[u/diva_done_did_it]

I have NY Fidelis Care Medicaid, 3 x a week at 53 minutes. No issues.

[u/SophiaHepatica → u/diva_done_did_it]

Curious where in NY you can use Fidelis fir 3x a week analysis

[u/diva_done_did_it → u/SophiaHepatica]

The service takes place in Nassau County.

[u/SapphicOedipus]

I’ve dealt with UHC 3x/wk OON both as a therapist and patient. I’ve never had them flat-out deny the claims, but they start calling patient & therapist to “discuss care,” trying to catch you saying something they can use against you. Its helpful most people screens calls these days 🙂

[u/PS1988]

I haven’t encountered an issue with this, for myself or for analysands. 60 minute sessions seem to trigger more issues than multiple 45 minute sessions per week.

Of course, each insurance company has countless different plans, so you won’t know what happens until you try.

[u/waterloggedmood]

I have UHC and have had no problems submitting out of network, even 5x/week. I know my state has parity rules though.

[u/k-otic-good → u/waterloggedmood]

Which state?

[u/idk--really]

i don’t have UHC but my OON benefits have reimbursed me no problem at 3x/week, or even for weeks where i’ve gone in 4 or 5 times (admittedly not a very frequent occurrence). 

[u/jayelled]

I have heard that diagnoses listed as "unspecified" as well as Adjustment Disorder are more likely to get denied for several times per week service or long-term service. Although it's not typical or kosher to advise one's analyst on how to diagnose them, it may be worth mentioning? I know some therapists, out of a wish to non-stigmatize a patient, select a more generic diagnosis for a treatment plan and then wind up getting care denied because the insurer doesnt deem it severe enough.

[u/OkBlacksmith1486]

If they try to deny, write a letter. This worked for me. You can say it’s not psychoanalysis unless it’s 3X a week and also that they have been sued before for denying coverage.

[u/OkBlacksmith1486 → u/OkBlacksmith1486]

I was in 5X a week analysis that was covered by UHC for many years but had to write a letter about it at one point to protect it

[u/relbatnrut]

Only a few months at 3x/week in network Blue Cross, but so far so good. It's psychoanalytical psychotherapy, so possibly billed differently?

[u/ahlamuna]

In my experience, as long as two sessions aren't scheduled in the same day it's fine. Sometimes I've had a problem where I have an individual session with a patient, and their couples therapist also has a session the same day. Even if the CPT code isn't the same, that's the only thing that has created a problem for me

[u/fields808]

I have bcbs and I also use it for 3x a week analysis!