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Managed Care / Insurance

Today, almost all Health Insurance Plans are managed to some degree; some are more strictly managed than others.

About Insurance Coverage

Commercial insurance plans may be managed by the insurance company itself or by another managed care organization. The rules for benefit coverage may vary depending upon whether the clinician is “in network,” or “out of network.” In most cases “managed” generally means the company will make decisions about what services are covered and what benefits can be used.

Insurance companies may also require additional information about the patient, the clinical problems, and/or treatment before making decisions about authorizing the use of benefits. They often base their decisions according to whether THEY consider treatment to be “medically necessary.” To our knowledge, this is an insurance company term and not a clinical one. This determination is NOT made by the clinician treating the patient.

The clinicians at BHI are on many insurance and managed care panels, but not all. If you are interested in using your insurance coverage, we will be able to tell you if we are on your plan, and verify your benefits. If you choose to use your insurance, our office will file claims for you. Any portion of the fees not covered by insurance is the responsibility of the patient.

Whatever type of insurance plan you may have, it is important that you understand how it works, what types of services it covers, and what it does not cover.

Why You May Decide NOT to Use Your Insurance Coverage

Because of concerns about private information being shared with insurance and managed care companies, and how this information is being used, many individuals are choosing not to utilize their benefits, and to pay privately for services. Please contact us at 954-340-0888 and speak with one of our staff members for further information.