But changing insurance doesn`t mean goodbye. It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients. This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network. In this case, the patient usually makes the case with the assurance of an ACS with you before starting treatment. There are many therapeutic processes, such as ABA therapy, where continuity of care is essential to achieving treatment goals. When a customer switches to a new insurance provider, it is essential to maintain continuity of care or put in place a transition plan to a new network provider. In many of these scenarios, it is often necessary to negotiate an agreement on a case-by-case basis. For a long-term patient, the new insurance company can respond positively to your justification for continuity of care.
If the patient cannot afford the benefits of OON to see you, and if there could be setbacks, if they were to start over with a new (network) therapist, make sure the insurance company is aware of this. If the patient has recently switched insurance providers, the insurance company may accept a limited number of sessions (approximately 10) and a period (for example. B 60 days since the insurance change) to allow the patient to continue treatment with the current network provider while switching to a network provider. If there is evidence that the person could pose a danger to himself or others, or if it affects the patient psychologically or mentally (for example. B failures in the progress of therapy), if this proves necessary to switch to an in-network provider, a case could be advanced for an increase in adequacy with the current provider. Examples: a patient has an uncertain bond and finds it very difficult to trust others. The therapeutic relationship already established with the current supplier can be considered as a factor in granting the SCA. Once an agreement has been reached, the new conditions set out in the CSA will apply. Since an CAS is rarely dated, it is important for the patient to understand his or her financial responsibility in all the intermediate windows between coverage or where the CAS is not granted.