Understanding Insurance Benefits & Coverage

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With all of the insurance changes coming in the New Year, we wanted to provide you with a summary of how insurance benefits typically work. The following are useful definitions for you to use when finding out your coverage for 2014.

In-Network Providers: Some licensed therapists (LMHC’s) sign contracts with insurance companies to provide services and are reimbursed by insurance companies at a fixed rate. These contracted therapists are called “In-Network Providers”. Insurance companies prefer that you use In-Network Providers. The contracted reimbursement rates are typically much lower than the rates most LMHC’s charge for services.

Out-of Network Providers: Many insurance companies will also reimburse if you receive services from an “Out-of-Network” Provider. This reimbursement works differently, as there is no contracted reimbursement rate. Insurance companies will typically reimburse either a set amount (for example, $65/session, no matter the cost of the session) or a percentage of the session cost (for example, 50% of the amount billed). You are then responsible for paying the difference between what the therapist charges ($100/session, for example), and what the insurance company reimburses (for example, 50%, or $50).

Deductible: The minimum amount the patient must pay before the insurance company will pay anything towards the charges/benefits will begin. This is paid out of pocket to the provider of the services, not to the insurance company. Often times insurance plans have separate In-Network and Out-of-Network deductibles.


Happy New Year!

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What moments will define your life in 2014? During a week of new years resolutions to be a better you full of “oughts” and “shoulds”, I challenge you not look ahead so much as look back. What was meaningful in your life this year? What went well? What are you proud of? These questions can help you understand your values and help set goals for the new year that you can attain. Many articles outline what researchers have found are the keys to goal setting. They are these five things:

1. Understandable: Make your goals specific.

2. Doable: Don’t set yourself up for failure, but also challenge yourself a bit.

3. Measurable: How do you know when you have achieved it?

4. Written: Write it on your door, mirror, sticky on your kitchen.

5. Habit Forming: 15-21 days forms a habit.

Although I think these are very essential, they are missing a key component. MOTIVATION. For us to be motivated, we need support from others who know our goals, encourage and hold us accountable to achieve them. We can help with that.

Here is to a healthy and blessed New Year to all of you!

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