Edify Counseling & Consulting

Frequently Answered Questions (FAQ's)

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"I'm thinking of using my insurance benefits. Are there advantages and disadvantages?"

 

Absolutely. Here are some pro's and con's that I've encountered:

Pros C

  • Money: you only pay your copay, if you have one
  • It can provide structure in that sessions will be limited
  • Referrals will be to in-network providers whose credentials have been verified
  • Increased coordination of with prescribing provider (which is expected)
  • When care is not approved, there is usually an appeal process (depending on policy).

 

Cons D

  • Limited sessions
  • Benefit limits depend on the policy your employer has purchased
  • You may not have out-of-network benefits so have to see only in-network providers
  • Care usually has to be pre-approved
  • You have to be given a diagnosis in order for the provider to get reimbursed; The diagnosis can follow you and some people have had trouble getting self-employed coverage later;
  • There may be no in-network providers in the network with your needed specialty; if you want to used a specialist, you may have to fight for it (appeal)
  • In-network providers may not be conveniently located
  • Available appointment times might not fit your schedule (but this can happen with any provider)
  • Confidentiality is limited: details about your problem and treatment course have to be given to the managed care representative (but not therapy notes)
  • Your provider may feel “inconvenienced” by needing to authorize more care, and may be reluctant to do so
  • Non-approved and non-authorized care will not be covered.

Edify Counseling & Consulting PO Box 511  Edgewater, NJ   USA  07020 Phone: (201) 312-5595