Insurance Information

The first thing to know about insurance is that Mental health insurance is not the same as Medical Insurance. When going to the medical doctor a person doesn’t have to care about the diagnosis, it is covered with a co-payment. However, there are a multitude of insurance policies and plans, and yet, one thing that all insurance policies agree upon is that only certain disorders are covered by insurance. Expecting that all or any of the sessions will be covered is not an accurate expectation. Only the more severe diagnoses (such as Major Depression, Bipolar I and II, PTSD, etc) are covered by insurance, which does not include couples counseling or sexual matters. And if an individual is not severe enough to meet the requirements of a disorder, the insurance company will reject the claim. A group of employees of the insurance company will decide whether you “should” get insurance or not. This is a decision for the client and the therapist to make, not the insurance companies.

One might think to oneself: “So… just lie about the diagnosis so we all get our money back”. But this is unwise because of the second thing you should know about insurance. The diagnosis that is entered on a claim is recorded on something called “The National Data Bank”. Even a prescription, not taken, is recorded and shows compliance. This Bank is supposed to be private information; however, there are ways for certain industries to access this information that can be used against an individual. A mis-diagnosis can be a very serious matter in deed. The delicate and very private information in therapy should be between the client and the therapist only.

Most of Nanette’s clients carry insurance and yet do not use it. That being said, if a client decides to use insurance, Ms. Sebourn will give those clients a Super Bill that the client can submit to their insurance company and receive reimbursement themselves. This is only possible with PPO insurance policies. The client will be responsible for the full fee at time of service and reimbursement will go to the client personally. Be advised that the reimbursement will be a partial amount of the total fee if accepted by the insurance company.

For more information on the problems with Managed care, click here and read an article by Dr. Ofer Zur, titled “Beware of Managed Care”.

41690 Enterprise Circle North, Suite 216, Temecula, California 92590 - Phone (951) 551-4484
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Providing Individual Counseling, Couples Counseling, Sex Therapy and Family Counseling in Temecula.