Will my health insurance pay for counseling?

Although most providers require you to take ultimate responsibility for paying your bill, health insurance may reimburse you or your healthcare provider for medically necessary treatment for covered, diagnosed conditions that impair your ability to function. They do not generally pay for counseling to relieve stress, enhance or maintain wellbeing or prevent problems down the road.

The exception to this rule is that some employers provide employee assistance programs which offer limited counseling for short term problems or crisis. Often these programs are limited to three sessions and then they refer you on to another provider for further treatment, which, if it is medically necessary may be covered by insurance.

That means you must

• Be diagnosed with a condition that meets the standard diagnostic criteria (these conditions are described in detail in a manual: (DSMIV).
• Be unable to function normally without treatment.
• Receive treatment intended to relieve that condition.

Finally, you must be willing to release that information about yourself to your insurance company and willing to have that information in your permanent medical record.

Whoa…What about confidentiality?

You should have complete confidentiality (assuming you don’t present a threat to yourself or others) if you are paying for your own care. If you ask your insurer to pick up the tab, legally, they gain complete access to your record. Once you grant your therapist permission to contact them, you have given up confidentiality regarding them. Of course, insurers are also required to keep your records private (HIPAA). However, your information may end up being part of a database (MIB) that collects health records from insurance companies.

Practically speaking, the amount of information required by insurers varies considerably. Some only ever ask for a diagnosis and billing information. Others want a lot of specific personal information about your condition and the treatment plan, and expect to dictate the level of and length of care needed. Many experienced therapists avoid dealing with insurance companies like this. That’s why you may find the counselors your friends recommend may not take your insurance.

My problems aren’t a serious medical problem. Should I hold off on counseling until they are?

If that’s the case, it is often a very good idea to spend some money out of your own pocket to get counseling for stress, for relationship problems or to prevent more serious problems. Most healthy people find themselves depressed or anxious at some point. Getting help early can prevent a whole lot of suffering later, and it can help you avoid losing your ability to function at work or home. Short term counseling is no more expensive than, for instance, the 15,000 mile service to your car, a vacation or a new laptop.

I already have a therapist. Can my counseling there be covered by insurance?

You should check with your health insurance plan and with your therapist to see if your treatment can be covered by insurance. Not all plans cover mental health, although any company offering insurance in Chicago or in Illinois must also provide some coverage of mental illnesses.

NEED A PHONE OR EMAIL CONSULT WITH THE THERAPIST FIRST? Email Elizabeth@elizabethritzman.com or call (866) 225-9196 or (708) 848-9900 and leave a message with your phone number and some good times to return the call. You’ll hear from us soon!

LOCATION:
AltCare Health Center

831 South Oak Park Avenue

Oak Park, IL 60304

Mapquest: Click

PARKING: Find Metered Parking on the street and behind the bank across the street.

Information for New Patients

Click here to Download the Word Doc: New Patient Information and Consent Form

New Patient Information: When you come for your first visit, you will receive information about counseling upfront and in writing. Feel free to print this and bring it along - with any questions- if you wish.

INTRODUCTION AND CONSENT TO TREAT:

Client(s) Name: _________________________

Address: ______________________________

Phone Numbers: ____________________________________

Date(s) of Birth ________________________

YOUR COUNSELING DECISION: This introduction is provided for you to take home, read and discuss (if you are in a couple or family), sign and return at the second session. You may copy this document for your own records. Your decision to enter counseling is a very important step in your life and growth. Whether this counseling is for you alone or as a couple, or as a part of a family, it is a gift - a gift of respect- for yourself and your relationships.

RISKS: Most studies show talk therapy to be a highly effective treatment, however not all people experience improvement from psychotherapy and therapy may be emotionally painful at times. Patients have the right to refuse or to discontinue services at any time. Therapy is not intended to be mysterious or harmful. Your concerns about the process of treatment and its effect on you will be welcomed at all times, and you are urged to bring any concerns about negative effects to the attention of your therapist right away.

FEE: Fees are based on our cost of providing professional services to you and on your ability to pay. Payment is made for a unit of service (a counseling session) and not for a certain number of minutes or participants. If ever you have concerns or difficulties with fees or payment, please let your therapist know right away. Although the usual session is 45 to 50 minutes, the precise length may vary. Often couples and families schedule “double” sessions. Call for our current fee schedule: (708) 848-9900 or email Elizabeth@elizabethritzman.com.

PAYMENT AND INSURANCE: Please pay at the time of service. In order to keep fees low, we have no billing service, nor do we take assignment from insurance companies. (However, we do bill for Blue Cross Blue Shield PPO.) We can provide you with the information you need to seek reimbursement from your insurance carrier. All client fees must be paid in full by the end of the month for counseling to continue. Periodically it may be necessary to adjust your fee, e.g. annually, or when weekly sessions become every other week or monthly.

SCHEDULING SESSIONS: For a successful therapy experience, it is important to establish an effective working relationship with the therapist with regular and consistent series of meetings. Sessions are usually scheduled one at a time either weekly, or every other week. On occasion, more frequent visits may be needed. Extended or double sessions are sometimes helpful, particularly for couples and families. During the time you are in counseling, plan to make your appointments one of the top priorities in your schedule.

Counseling requires the commitment of all parties involved. Clients usually find that it takes more than one session to determine if they have a good fit with their therapist. It also takes about 4-6 weeks for the therapist to complete a basic assessment and plan for treatment. If there is not a good fit, I am professionally committed to helping you find a therapist who will be a better match. This will be discussed with you during the initial session. You and I will develop your course in therapy together. If you should decide that you wish to terminate therapy, please give at least one week’s notice and plan for a summary interview to effectively end our work together.

Nothing about therapy is intended to be mysterious. Anything your therapist says or does is open for discussion. Please feel free to ask questions at any time about the therapeutic relationship or business matters.

CANCELLATIONS: Because your therapy is so important, your appointment is reserved for you and is not available to anyone else. Please call immediately if you must cancel. Cancellation of appointments without charge is possible only in the case of illness, injury or extreme emergency. Normal charges are incurred for missed appointments. If you must cancel, and if we are able to reschedule within that work week, you will not be charged for the first missed appointment.

CONFIDENTIALITY: Confidentiality is taken very seriously. As a client you have a legal right to have your work kept private. This is your right to confidentiality and it is generally the duty of your therapist not disclose to anyone anything you reveal in your session. As you begin your therapy journey, it is important that you talk with your therapist about the limits to confidentiality in therapy.

Most of the time these limits do not affect therapy. However, Illinois law does require that your therapist tell others about things you have talked about in therapy in certain cases. It is important that you understand these exceptions.

1. The courts can require your therapist to release details that involve murder, deciding mental competency, or in cases in which wills are challenged.

2. Your therapist must tell others if there is a clear risk of serious physical or other harm occurring to yourself or others. That is, if you threaten to hurt yourself or others your therapist is required by law to report that information.

3. Illinois law requires your therapist to report within 24 hours if he or she suspects child abuse or neglect.

4. Illinois law also allows your therapist to share details of your case with supervisors, consultants, appropriate staff, or others reviewing your case for the purpose of assuring the quality of therapy.

5. With your written permission, your therapist may reveal certain information to your insurance company. Usually you give that permission when you sign a claim form, or sign the following release.

6. With your direct written permission, your therapist can give information to others that you request; e.g. your physician or school counselors.

In our experience these limits to confidentiality rarely pose a problem for our clients. We feel that informing you at the onset of our work together adds to the trust that will grow between you and your therapist.If you are required to sign a release for psychotherapy records if you are involved in litigation or other matters with private or public agencies, think carefully and consult with an attorney and your therapist before you sign away your right to the privacy of your confidential medical records.

If you are bringing your children in for therapy, it is important to think about how we will work together to balance your need for information as a parent with the need of children to establish an open and trusting relationship with the therapist. In therapy children are encouraged to communicate directly with parents about counseling and all matters of importance. Often parents and children work together in therapy to facilitate this relationship.

TREATMENT OF MINORS:

In Illinois, children over the age of twelve can consent to their own brief mental health care if necessary. This is a new law, which has received the grateful support of most parents because it provides for the immediate care of children in high risk situations. However, it is our philosophy that the wellbeing of children is most often intimately tied to their relationship with their parent or parents or guardians. Respectful care of the whole family is our preferred approach to helping children.

In this office all clients have both rights and responsibilities.

You have the right to:

1. receive courteous, professional treatment at all times, including an atmosphere free of sexual harassment or abuse,

2. participate in the development of your treatment plan,

3. review your record and insert comments correcting personal information, in the presence of your therapist.

You also have the responsibility to:

1 cooperate with the goals you established with your therapist,

2 be present for all appointments; and

3 pay for counseling at the time of service.

Betsy Ritzman is a Licensed Clinical Professional Counselor. Her Illinois License number is 180-001294. She is a member of the American Association of Pastoral Counselors. She has a Masters of Science in Counseling and a Master of Divinity in Pastoral Counseling. Please feel free to ask her about her credentials, experience, and any other information you would appreciate.

Consent to Treat I agree to attend (Fill in one): a) ___sessions, b)___Open ended sessions. The fee for my counseling as mutually agreed upon is ____ per session.

To use insurance if appropriate: I wish my therapist to disclose a diagnosis and other clinical information to my insurance company. Thus, (please sign the following:) “I authorize the release of any psychological information necessary to process insurance claims.”

Signature:__________________________ Date _____________

I have read, understood and accept the preceding information and guidelines about counseling and confidentiality.

Client Signature ____________________________ Date _______

Therapist Signature _________________________ Date ________

EMERGENCY NAME: If we need to contact someone in a dire emergency on your behalf who do you wish that to be? Fortunately, this is hardly ever necessary. Thank you.

Name ______________________________

Phone ______________________________

Relationship _________________________________________

MAIL

It is acceptable to contact me by mail: ___ Yes ___ No

HIPAA

At your first visit you will be required to sign a statement that you have received information about your rights under HIPPA. This is now a routine practice for all health care visits, including counseling and mental health care.

WHAT IS HIPAA?

“HIPAA” is an acronym for the Health Insurance Portability & Accountability Act of 1996 (August 21), Public Law 104-191, which amended the Internal Revenue Service Code of 1986. Also known as the Kennedy-Kassebaum Act, the Act includes a section, Title II, entitled Administrative Simplification, requiring:

1. Improved efficiency in healthcare delivery by standardizing electronic data interchange, and
2. Protection of confidentiality and security of health data through setting and enforcing standards.

More specifically, HIPAA called upon the Department of Health and Human Services (HHS) to publish new rules that will ensure:

1. Standardization of electronic patient health, administrative and financial data
2. Unique health identifiers for individuals, employers, health plans and health care providers
3. Security standards protecting the confidentiality and integrity of “individually identifiable health information,” past, present or future.

Who is affected? Virtually all healthcare organizations – including all healthcare providers, health plans, public health authorities, healthcare clearinghouses, and self-ensured employers – as well as life insurers, information systems vendors, various service organizations, and universities.

Are there penalties? HIPAA calls for severe civil and criminal penalties for non-compliance.

How does this affect my counseling? We meet the compliance requirements for HIPPA which include:

• Comprehensive assessment of our business privacy practices, information security systems and procedures, and use of electronic transactions.
• Our electronic billing service is secure and HIPPA compliant. If you wish you may opt out of e-commerce by asking our front desk staff. Infrequently, and only at the request and initiation of clients I will respond to emails. Our policies, processes, and procedures are intended to protect privacy, security and patients’ rights.

• Our business associate agreements support HIPAA objectives.
• We are developing and maintaining a secure technical and physical information infrastructure.
• We update information systems to safeguard protected health information (PHI) and enable use of standard claims and related transactions.
• We train all workforce members on HIPPA.
• We have developed and maintain an internal privacy and security management and enforcement infrastructure, including providing a Privacy Officer and a Security Officer, Dr. Cheryl Haugh 831 South Oak Park Ave. Oak Park IL 60304 (708) 848-9900.

More information about HIPPA is available at www.hhs.gov/ocr/hipaa/