Insurance Information You Need to Know

InsuranceNow An Important Word About Your Insurance:

Dr. Adams is in network with most insurance plans. We know how important it is to you that your psychologist share the same insurance networks as your primary care and other specialist providers.

  • Many mental health providers do not participate in networks and tell patients that this protects their privacy and removes all constraints on the care provided. This is inaccurate and misleading.
  • In Network Providers are carefully screened by insurers and are governed by “usual and customary charges” as determined by a set fee schedule.
  • By not participating in insurance networks, the provider is then free to charge you whatever rate he may choose.

And  Then An Important Word About “Out of Network (OON)” promises:

  1. Even if you have OON benefits, you may not be reimbursed at all if the insurance company has credentialed in-network providers who deliver the same or better quality of care.
  2. Your health insurance company may deny reimbursement for fees you have paid to OON providers for other important reasons such as deeming that a “therapist” (a non-regulated term) does not meet appropriate educational and credentialing standards.
  3. If you are reimbursed for care by an OON provider, it may be at a much lower rate than you will be reimbursed for “in-network” providers. You will still need a diagnostic code from whomever you see to receive reimbursement if any.
  4. By having you go “out of network,” the provider is asking you to assuming the complex tasks and responsibilities that should be covered by office staff. You are then performing the office’s clerical responsibilities.
  5. By an OON provider stating that he has chosen to not participate in an insurance plan may indicate that either he does not qualify and/or did not wish to engage in the laborious and sometimes lengthy provider application process.

Contrary to what cash- and credit-card-only providers claim, insurance companies do not control in-network providers, request office notes or other HIPAA-protected data. Most insurance plans allow unlimited visits with a “co-pay.” This co-pay helps meet your annual medical deductible, and the plan protects you from potentially being overcharged by an OON provider.

Cash and price may not equate to quality. Your health care is your decision so stay informed from impartial websites such as:

Dr. Adams is in network with most, but not all insurers, and he is not a Medicaid, Cigna or TriCare provider.

Call the number of the back of your insurance card to see if we are in network. Dr. Adams’ NPI number is 1598781023. You may also call our office for assistance in determining your insurance coverage for care in this office.

Dr. Adams is in network with the following insurance companies:

  • Multiplan
  • Medicare
  • Aetna (all)
  • BCBS (all)
  • Humana
  • United Healthcare
  • Chartis
  • Broadspire
  • Concentra network
  • First Health network
  • Companion Benefit Alternatives
  • Optum Behavioral Health
  • Cambridge Services
  • PHCS LiveWell
  • PCIP
  • MHNet

The Non-Psych Claim

As I have often stated, the workers_ comp system is ill-equipped to deal with those of above average intelligence, greater …
Read Blog Post

Capacity vs. Willingness

If you have someone who is fully recovered, who seems to be honest, but who passively blocks all efforts to return him to …
Read Blog Post

The Path of Diagnosis

The ruling-in of psychological disorders in cases of injury and illness arises from both, fear and avoidance. The authorized …
Read Blog Post