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Help me to find out how to get my out of network therapist covered


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I've been depressed almost all my life. I was diagnosed at ten, twenty-one years ago (you do the math). I've gotten SSI and Medicaid since 2011. Before that I was under my parents' insurance and saw a particular psychologist and when that ended I saw someone at a counseling center, who left for private practice. I'd happily see either of them. However, even after getting a Blue Cross Medicaid program neither are covered. I can't make myself see a new therapist because those two already know a bunch of stuff that I can't make myself talk about (someone else told them in both cases). They are both covered by Blue Cross in my state, but not the Medicaid portion of it, and both are too expensive to see on my own. I've looked to find some sort of psychiatric insurance plan in hopes that one would work, but no go.

 

When I signed up for the Blue Cross plan, I was told that my PCP could write me a referral to either under the continuity of care clause. However, the PCP I saw said that wasn't possible. I don't know what to do about it. Therapy is something that helps me and not seeing one is hard (although not as hard as seeing a new therapist). Is there something I can do to see either one of them and somehow get it covered?

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Ask your tdoc to contact the insurance company on your behalf to ask for a "single case agreement" for the clinical reasons you have outlined above, being sure to mention "continuity of care due to change of insurance."

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I have no idea.

 

The treating provider or the patient has to initiate the single case agreement request, though. So I'm not sure how talking to your pdoc would help tdoc make a request.

 

Make sure you use the phrase "single case agreement". This is insurance language for "let's make a one-off contract between us and the provider to cover services for this one person" for a non-network provider.

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Exactly as I have said...

 

Call the tdoc you used to work with.

 

Tell them you want to work with them again, but they aren't covered by your insurance and you can't afford to pay out of pocket.

 

Ask if they would be willing to contact your insurance company to help determine if a "single case agreement" could be made for "continuity of care" or "to prevent deterioration in an established therapeutic relationship".

 

If they are willing to do this, they call the benefits department of your insurance company to start the request.

 

You may also have to call in to request the single case agreement. The tdoc should tell you what they find out when they talk to the insurance people.

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