THE INSIDE STORY ON INSURANCE
MY FEE IS $180 AND I AM OUT OF NETWORK, as are all private specialists competent to treat acute anxiety disorders. I only want to be sure you get the right kind of therapy, regardless of whether you choose to see me or someone else.
Every therapist says they treat anxiety disorders, but don't waste time and money and suffer longer seeking help from someone on your insurance plan. There simply are no therapists on any plan that are specialized to treat anxiety disorders. They are generalists, who might be good for talking about relationships, a crisis, or self esteem, but not an acute anxiety disorder. Why is this? Therapy is like anything else; you get what you pay for, and a $50 therapist does not offer the same expertise. To learn more, EMAIL A QUESTION or request a free consultation within 24 hours. Or MAKE AN APPOINTMENT INSTANTLY ONLINE or by calling 212-726-2390.
TREATMENT FOR PANIC, ANXIETY, AND PTSD IS MORE AFFORDABLE THAN EVER BEFORE.
Most clients' insurance reimburses them for the vast majority of my fee and offer a generous number of sessions. If you have out of network coverage, they will cover one-third to 80% after an initial deductible.
If you don't have out of network coverage,
I WILL NEGOTIATE WITH YOUR INSURANCE TO COVER ME:
I am often successful in negotiating with most major insurance HMOs, EPOs, and Managed Medicaid (Americhoice, HealthPlus, etc.) to cover me as if I'm in-network. If successful, that means you will still pay my full fee at each appointment, but your insurance will pay you back most or all of my fee except your standard copay. It's not a guarantee, it takes a month to get a decision, but they might approve it retroactively. It involves some hassle on the client's part, but it costs nothing to try and is often successful. It requires you to start the process. Please follow the instructions below exactly as they are written.
1. Please call your policy’s customer service department (on your insurance card) and tell them: “I am seeking a ‘single case agreement’ to cover an out of network psychologist that I am seeing.” (Sometimes it might be called an "ad hoc agreement" or "exception authorization" or "exception accommodation" or even "in-for-out.")
2. They might transfer you to an “intake” person or "care advocate" who will just take down basic facts. Get the names of all people you talked to. Tell them the following:
a. “I am seeking a ‘single case agreement’ to cover services of a psychologist I am seeing. I need a male psychologist in my area who treats Panic, Social Anxiety, PTSD, or OCD with exposure therapy, and who can provide therapy outside of his office, and I called all the providers on the list and none fit this description.” (If you wish to tell them that you want “a therapist who is religious,” which I happen to be, it will greatly improve your chances; you don’t have to justify why. If they say you can't choose the religion of your therapist, just say you want someone "initimately familiar" with the details your religion.)
b. Emphasize that Exposure Therapy is the only therapy recommended for Panic, Social Anxiety, PTSD, or OCD by the National Institute of Mental Health and the Anxiety and Depression Association of America.
c. Ask them to call Dr. Brodsky at 212-726-2390 "to negotiate a fee" and cover his services. Usually, they will just take the facts (they will not argue with you). Before you hang up, get a “reference number” for your discussion. This will ensure they approve coverage retroactive to that date. If they won't call me, ask them if there's a fax number I can fax the request. If they don't, try to get a direct number or extension for me to call. This will speed up the process. If you can't get that, at least get the number for their "Behavioral Health" division.
3. Usually they tell you they will send your case to a “care manager” or “care advocate” or “utilization manager” who conducts a “clinical review” of your case. Next, the care manager will talk to Dr. Brodsky to get further details to justify “medical necessity.”
4. If they give you a hard time, which is very rare:
a. You can prove the necessity of Exposure Therapy by showing them the documents from these organizations, which appear on my full website under "Insurance."
b. Ask to speak to a supervisor if the person you are speaking with can’t help you.
c. If they say you can’t specify religion, which is highly unlikely, you can still tell them you only feel comfortable with someone who is religious in general, or who is intimately knowledgable of the details of your faith.
d. They might send you several suggested in-network therapists to call first before authorizing Dr. Brodsky. Just call your insurance back the next day and tell them you called everyone on their list and they either don't do Exposure, don't specialize in your condition, aren't male, made you uncomfortable religiously, wasn't willing to do therapy outside the office, aren't taking new clients, or didn't return your call.
5. Bottom line, don’t take no for an answer. If they ever give you a hard time, remind them: “You are legally required to cover appropriate treatment of my condition (even if they are an HMO), and must make alternate arrangements if your providers can’t treat me.”
6. If they finally deny your request in writing, you may appeal their decision twice. For more details on this option see my full site and click "Insurance and Fees."