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. 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. 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. Ask him if I`m a network provider. If they don`t show me as a supplier, you can ask them to make a deal with me once (so-called "case-by-case agreement") or you can find out about their Out-of-Network (OON) policy. OON usually implies that the member is paid first for therapy and then reimbursed by the insurance company for some or, in some cases, the full fee. 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. Allows members to obtain health care wherever they live or travel, nationally or internationally. BlueCard connects participating healthcare providers and independent Blue Cross Blue Shield businesses across the country through a unique electronic claims processing and refund network. A person or organization that cares for patients from outside the local plan.