Insurance Information

What Insurance Plans are accepted?

Psychological Associates, P.A. accepts and can bill most major indemnity insurance plans as well as Medicare. (Indemnity insurance plans are those that are not managed, that is, they are not HMO's or PPO's.)  Health Maintenance Organizations (HMO's) and Preferred Provider Organizations (PPO's) accept specific clinician providers to their panels. At the time you make your appointment, our staff can assist you in checking coverage with your HMO, PPO, or other insurance plan.

 

Are there any things I need to know when using an HMO?

Health Maintenance Organizations are designed to improve care and decrease health care costs. They try to improve care by setting standards for clinician providers and treatment plans. They decrease costs by not paying for health care treatment they believe is not "medically necessary." "Medical necessity" is not the same as the "standard of care." Medical necessity criteria are developed and determined by each HMO, and may be different from one HMO to another. When you use an HMO, there are four issues that you need to know about: (1) Even though the treatment plan is agreed between the clinician provider and the client, the HMO is responsible for deciding if they will pay for the care outlined in the treatment plan. If payment for care is denied, the clinician provider can appeal the HMO's decision, but the HMO itself has the final decision about determining "medical necessity" and payment. (2) An HMO needs to be given information in order to make their decisions and verify that the treatment given meets the HMO's standards. HMO contracts require that clinician providers give the HMO their records about a client if the HMO requests them. Once information or records is given to the HMO, the HMO may give information to other selected organizations without the client's or clinician's  knowledge or consent. (3) The clinician provider is legally required to follow the HMO policies, procedures, and standards, as well as specific state and federal laws and regulations that relate to HMO practices. This can result in a clinician provider developing a different treatment plan for an HMO recipient than would be developed if the client had no HMO coverage. (4) HMO and PPO contracts require that providers collect co-payments at the time of the office visit.

 

Is Medicaid ("Medipass") accepted?

Although straight Medicaid is not accepted, Medipass is accepted at Psychological Associates, P.A. The state governments of Florida and Alabama have funded extensive services in the Community Mental Health Centers for Medicaid and Medipass recipients. In Escambia County and Santa Rosa County, Florida, the Lakeview Center (850-432-1222) is a Community Mental Health Center which provides mental health services for adults and children.  Children's Home Society (850-494-5975) is also licensed as a Community Mental Health Center which provides mental health services for children and adolescents.

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Usage Agreement

July, 2001