Fees and Insurance
Most psychotherapy services in Kansas are covered by health insurance. However, you may have to call the number on the back of your insurance card to get prior authorization. Family Psychological Services directly bills most insurance plans. Other plans allow out-of-network benefits. Please contact your health insurance providers to find out the details of your coverage. Copay, deductible, coinsurance and any other services not covered by your insurance, must be paid at time of service via a credit card on file or on a payment plan, as described below. Due to restrictive Medicare billing policies and auditing procedures, we only serve Medicare patients within scope of practice on an "opt-out" cash only basis.
Please note that we DO NOT participate in or subscribe to Simplicy Healthcare Payment Systems. You must cover all your costs direcdtly with our office.
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Sheild of KC PPO (Not HMO)*
ValueOptions
KanCare Plans
Cigna Behavioral Health Care
United Health Care (via Optima)
Aetna (including former Coventry)
*BCBS of Kansas City no longer pays office visits for psychotherapy services, meaning that all such services must be paid by the client in full at time of service until the deductible is met. We strongly disagree with this practice, and have seen it in no other company in the United States, but we are not in a position to dispute it. Please check your deductible, before scheduling to get an idea of your portion of the healthcare cost.
You must upload your insurance card before your first appointment or bring it with you and resubmit it anytime your insurance plan/company changes. If you do not, you will be considered a self-paying client until the card can be presented and required ot pay for services at time of delivery.
Carefully Consider Why You Might NOT Want to Use Insurance: Today's insurance market is a complex place to do business, whether you are a carrier, a provider like Family Psychological Services, or a covered life, like you. Historically in Kansas, insurance carriers were regulated closely by a powerful insurance commissioner who took seriously consumer protection and advocacy. As the political winds have shifted that is no longer true, and consumers should look closely at their insurance benefits, particularly when used in the highly sensitive area of psychotherapy and psychoharmacology.
Medical Records Auditing. The largest insurer in Kansas, Topeka-based Blue Cross and Blue Shield of Kansas (BCBS of KS) retains the right of full access to members Protected Health Information (PHI) record in order to determine “medical necessity” for treatment. BCBS of KS notes that other insurers also retain this right. However, the only commerical insurer who has set forth with our office specific guidelines for auditing to determine medical necessity is BCBS of KS. Medicaid (KanCare) contractors are also known for auditing medical records to determine medical necessity and in some cases, practices have been recouped for the costs of services already delievered. Medicare has history of being aggressive in this form of auditing which is why our office does not take Medicare and limites our exposure to KanCare. To be very clear, neither BCBS of Kansas nor any KanCare contractor has audited Family Psychological Services records for this purpose.
Auditing means that your psychiatric records may be reviewed by the insurer or a company designated by the insurer for to determine if diagnosis, treatment planning, the intensity of the treatment schedule, and the goals meet the insurer's definition of medical necessity. While insurers state that the follow HIPAA requirements in exempting the “psychotherapy note,” which contains the most private process notes from your psychotherapy, much of information that might exist there is required to demonstrate medical necessity. While uncommon, it is possible that the insurance carrier or its sub contractor will request more information about your case than you feel comfortable revealing, and you are not free to decline nor will you be notified of the audit. Since 2016, FPS responded to this implied scrutiny by purchasing an elaborate electronic medical record (EMR) to both meet the requirements of BCBS while protecting sensitive patient data. You may find that this level of note-taking intrudes into your session, but it is a necessary part of the process of insurance reimbursement. While most of our clients use their insurance benefits, some elect not to file with insurance, greatly reducing the note-taking to only that necessary to meet the needs of the treatment process.
If you have a complaint or are dissatisfied with a denial of coverage for claims under your BCBS Kansas plan, you may be able to appeal or file a grievance. Contact BCBS Customer Service at 1-800-432-3990 or visit www.bcbsks.com/blueaccess. You may also contact the Kansas Insurance Department, 420 SW 9th Street, Topeka, Kansas 66612-1678, Phone: 800-432-2484, or visit www.ksinsurance.org, or the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa.
Security of Medical Records. All insurance companies are bound by federal HIPAA laws to protect your health records from improper release. However, a December, 17 2015 news story on NPR found that “Millions of private medical records have been hacked at large insurance companies like Anthem," a company which owns many of the BCBS companies around the United States (but does not own BCBS of Kansas or Kansas City). Most insurance companies hire cyber security firms to assure your records are protected. However, Family Psychological Services, LLC cannot be responsible for any information once it is released to any insurance company or any use to which that company might submit it.
Relationship (Marital) Therapy, Diagnosis, and Health Insurance Reimbursement: Critically Important Information. Insurance companies will NOT reimburse Family Psychological Services or any other provider for diagnostic codes dealing with relationship or sexual problems because these are not seen as "medically necessary." Services specifically for couples or sex therapy must be paid in cash at a rate of $165 for 90 minutes. We do not do shorter sessions for couples.
That said, to improve outcomes for the identified individual client, insurance companies often prefer to have family members involved in conjoint treatment. Our staff strongly prefer to include family members as needed, particularly married or exclusive couples in which one partner has a mental health diagnosis. This is not, however, martial or relationship therapy as defined by our professions. It is what is referred to as a "conjoint therapy process" intended to treat one of the partners for say, anxiety, ADHD, depression, bipolar disorder, etc. Partner participation can provide valuable treatment options, but the chart must be open on the identified and diagnosed client, the partner considered a "collateral" in that process, and the conjoint therapy must address the individual client's treatment goals.
This is also true of divorce therapy that is not responding to a specific mental health concern. Many times children and adults are having significant mental health problems adjusting to a divorce. Those services may be reimbursable by insurance because we can provide a diagnois and demonstrate medical necessity. However, coparenting therapy, supervised therapy with parent and child to reintegrate their relationship, and any forensic service related to divorce is NEVER reimbursable. Likewise, if you just want to talk over your divorce and get ideas for coping, this is a great idea, but probably NOT reimbursable.
To be clear, this is not a policy of Family Psychological Services, but a requirement under all insurance company contracts. Any provider who is billing for a marital-only or sex therapy (as opposed to conjoint services for an identified and properly diagnosed client) is doing so in violation of his or her contract with your insurance carrier, potentially committing insurance fraud and is subject to recoupment. Yes, we know those providers exist, but our office is unwilling to fudge a diagnosis to see anyone in a strictly marital therapy process.
