Steven T. Griggs, Ph.D.
PSY 8534
INSURANCE INFO |
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s therapy, counselor.) |
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Many clients initially want to know if I am a contracted provider with their insurance company. The following is a list of Insurance Companies, Managed Care Organizations (MCO’s), Preferred Provider Organizations (PPO’s), Health Maintenance Organizations (HMO’s), Employee Assistance Programs (EAP’s) or contracting/credentialing agencies with which I am currently enrolled with or have some "on paper" relationship as a provider. (Some of the below have plans within plans, and providers are not always matriculated into every plan within any given company. So, it’s always best to call your insurance company ahead of time, just to make sure. Scroll down to view the right questions to ask). Currently, virtually all companies supoport tele-counseling (video or telephonic), but it is always safer to confirm this with them first. Acentra Health (Formerly ESPYR) Availity (Provider credentialing service) I no longer take Optum's or Blue Shield's ("Promise") version of Medi-Cal (they gave me headaches...). Medi-Cal offered through MHN stops January 1, 2024, but may be picked up by their parent company, Health Net. Other versions of Medi-Cal (Aetna and Blue Cross) have either been stopped in California, or are unworkable. I am not contracted with Molina or Community Health Group.. If you have Medi-Cal, make sure you know which one and before calling me, or any provider. Medi-Cal has become very complicated. I don't work with Integrated Health Plan or Compsych. I tried a single case contract with HMSA, but they were truly one of the worst EAP's I've ever worked with, so I learned my lesson early with that one. The same is true of Curalink. I no longer conduct Employment Development Dept. (EDD), Social Security Income (SSI) or Workman's Compensation evaluations because of failure-to-pay issues. I no longer work with the Veterans Administration (VA) or CHAMPVA--both have excessive and highly inefficient paperwork that usually doesn't work. I also do not take any case that is likely to be involved with courts, nor do I write letters to courts, attorneys, etc. in cases that started out as "regular" cases, but later devolve. I no longer am a TERM provider, because like some of the above, they went to the "dark side." That means I no longer work with CPS/CWS cases. I’m not a provider with Kaiser, Psychiatric Centers, MHS (Mental Health Systems), Sharp, PsychCare or BHA (Behavioral Health Associates). These last six use their own, in-house, psychologists and other employees, hence don’t contract with outside providers. Psychologists are not allowed admitting privileges at psychiatric hospitals, nor do we usually treat clients at in-patient facilities. Hence, insurance companies will not cover our services if you are in a psychiatric hospital, with some rare exceptions, e.g., psychological testing. Additionally, I do coordinate and treat patients who have recently gone through inpatient or partial day hospitalization programs and who need additional support as they transition back into their work and family lives. These programs include: Aurora, LifeSync, Palomar, Project Oz, Alvarado Parkway, Serenity House, Neighborhood House, Interfaith, Tri-City, Passages, MacDonald's Center and Sharp-Mesa Vista. I work with clients who participate in Alcoholic Anonymous (Narcotic Anonymous, Marijuana Anonymous, Sex Addiction Anonymous, Al-Anon or any other 12 Step group). I work equally with non-12 Step oriented clients and programs, such as Smart Recovery. I still work with insurance companies because most clients are covered this way. (Many of my colleagues do not take insurance at all.) I do this despite the fact that insurance companies present additional and often unique challenges to both clients and providers, alike, i.e., telling the client one thing and later doing something else. Obtaining basic information in writing beforehand reduces misunderstandings. This especially applies to co-pays, number of authorized visits and billing addresses. I have found that even insurance companies will give out the wrong billing address, so pay more attention to this one. Insurance companies will provide the necessary information needed for you to make an informed decision regarding beginning treatment, but you have to call them. Before arriving for your first appointment, please call your insurance carrier. Their toll-free number is on the back of your insurance card under something like “Member Services.” Ask for "Benefits", tell them what we are up to and then ask them the below questions. Bring this information with you to the first appointment. I'll do the billing for you, but you have to provide ACCURATE information, especially "nowadays," because most of this is electronic. (No or wrong information, even being off by one letter or digit results in problems or outright failure.) I'll need a separate sheet for each identified patient, or a new sheet for each person in the event of any insurance changes.. (I've had professionals try to make the below questions into a form that you can fill out on line. They failed numerous times, so, print this page, or copy it to a word processor and fill it out so you won’t miss anything. Sorry, I tried...) For now, there is a separate, all electronic version of the below that makes it easier to get this and two other forms to me before we begin working together. These can be found on the Telehealth page (see buttons on the left of each page on this site. Telehealth is third from the bottom.)
Patient Name/Date of Birth/Gender:_______________/_________/ M__ F__ Patient's Social Security #: _______________________________________ Email:_______________________________________________________ Policy Holder's Name/Date of Birth:__________________/________/ M__F__ Policy Holder's Social Security #: ________________________________ Email:______________________________________________________ Name of Carrier: _____________________________________________ Effective (Start) Date: _________________________________________ Type of Product (PPO/HMO/EAP/EPO/POS):____________________ Special Billing codes? (99404 for EAP's) ___________________________ Billing Code Modifiers? (HJ?) ___________________________________ Member/Policy ID Number: ____________________________________ Group/Plan Number: _________________________________________ Authorization Number (if needed): _______________________________ Number of authorized visits (if relevant):___________________________ Beginning/Ending dates of authorizations: ____________/____________ Deductible amount/Deductible beginning date:__________/___________ Co-pay amount/visit: __________________________________________ Insurance Co. billing address: ____________________________________ ___________________________________________________________ Is there coverage for telecounseling? Videocounseling? Yes___/No___/?___ Insurance Telephone (and other numbers): For Providers/For Members:__________________/__________________ Insurance Co.'s Electronic Payer ID#:______________________________ Insurance Co.'s fax (for submitting billing, if all else fails): _______________________________ Signature. I certify that the above information has been given to me by my insurance ___________________________________ Today's Date ________________________
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