Insurance Claims: Empowering Your Clients for Coverage
$10.00
This program is presented in partnership between the Chicago School, the Kennedy Forum of Illinois, and the Austen Riggs Center
Presented by Joe Feldman, MBA, Eric Plakun, MD, Marie Casciari, JD, and the Honorable Patrick Kennedy
This program was recorded on November 16, 2021.
Access provided upon registration on “My Courses” page
Insurance coverage for mental health and substance use treatment has long been a challenge compared to coverage for physical health. While federal and state laws have been implemented over the last several years to require parity treatment (i.e., mental health same as physical health), it remains far too common that claims are denied and coverage is out-of-reach for individuals requiring such care. More recently, federal lawsuits have been won in favor of patients where insurers improperly, that is illegally, denied claims. Step-by-step, the landscape may be shifting so that patients will be less likely to confront denied claims. But we’re not there yet.
Insurers have denied claims for “lack of medical necessity” where that determination has been made independently of the patient’s treating clinician. Such denials may be confounding to both patients and to their clinicians. After all, who should be making the determination about whether care is indeed “medically necessary”?
Authors of a recently published article will describe their recommendation for clinicians to provide a “letter of medical necessity” to their patients as a tool to improve the likelihood that insurers timely approve claims. Such letters have proven crucial in lawsuits and appeals; they represent an important tool that clinicians can provide their patients.
Access provided upon registration on “My Courses” page
This program, when attended in its entirety, offers 1.0 CEs for Psychologists, 1.0 IL CEUS for Counselors and Social Workers, or 1.0 BBS California CEUs for LPCCs, LPSW, and LMFTs.
Description
This program is presented in partnership between the Chicago School, the Kennedy Forum of Illinois, and the Austen Riggs Center
Presented by Joe Feldman, MBA, Eric Plakun, MD, Marie Casciari, JD, and the Honorable Patrick Kennedy
This program was recorded on November 16, 2021.
Access provided upon registration on “My Courses” page
Insurance coverage for mental health and substance use treatment has long been a challenge compared to coverage for physical health. While federal and state laws have been implemented over the last several years to require parity treatment (i.e., mental health same as physical health), it remains far too common that claims are denied and coverage is out-of-reach for individuals requiring such care. More recently, federal lawsuits have been won in favor of patients where insurers improperly, that is illegally, denied claims. Step-by-step, the landscape may be shifting so that patients will be less likely to confront denied claims. But we’re not there yet.
Insurers have denied claims for “lack of medical necessity” where that determination has been made independently of the patient’s treating clinician. Such denials may be confounding to both patients and to their clinicians. After all, who should be making the determination about whether care is indeed “medically necessary”?
Authors of a recently published article will describe their recommendation for clinicians to provide a “letter of medical necessity” to their patients as a tool to improve the likelihood that insurers timely approve claims. Such letters have proven crucial in lawsuits and appeals; they represent an important tool that clinicians can provide their patients.
Access provided upon registration on “My Courses” page
This program, when attended in its entirety, offers 1.0 CEs for Psychologists, 1.0 IL CEUS for Counselors and Social Workers, or 1.0 BBS California CEUs for LPCCs, LPSW, and LMFTs.
