Insurance… or EAP?

Employee Assistance Programs (EAP)

Because EAP services are very limited, using EAP benefits are typically recommended to:

  • address very short-term problems or
  • to help the employee identify and access resources to help them have support for more complex or long-standing concerns.
  • Sometimes, people will start services with therapist covered by their EAP, but then need to transition to a different therapist using their health insurance if the EAP therapist is not a part of their insurance panel.
  • Please consider your needs and resources carefully.

Using health insurance for therapy requires that you meet “medical necessity” criteria.

  • A  mental-health diagnosis must be assessed and applied to you in order for me to bill and seek reimbursement for your health insurance for services.
  • The type, frequency and duration of services must also meet the standard of care/medical necessity criteria for the diagnosis.
  • Your insurance company may require me to submit copies of my records documenting the personal information you share to verify that appropriate services were provided and met medical necessity criteria.  When you sign up for your health insurance plan your authorization for providers to do this is implied.

Don’t want to use your health insurance?

My fee-for-service is negotiable for clients paying out of pocket.

Currently, I am a contracted provider for the following insurance plans:

  1. Aetna
  2. Anthem Blue Cross
  3. Blue Shield (except for plans that subcontract mental health to Magellan, the Mental Health Administrator)
  4. Evernorth (formerly Cigna)
  5. Medicare (I do not work with with Medi-Cal “Medi-Medi” as secondary insurance)
  6. Optum
  7. Other PPOs that allow you to see Out-of-Network providers
  8. PacifiCare Behavioral Health (Optum)
  9. State Compensation Insurance Fund Employee Assistant Program (EAP)
  10. Tricare for Life
  11. TriWest
  12. United Behavioral Health (Optum)
  13. U.S. Behavioral Health Plan (Optum)

Am I not in Your Network? 

Call your insurance company to see if you have “out of network” coverage or benefits. See below for help on this.

Important Steps to Help You Successfully Navigate Your Health Insurance

  1. Call your insurance plan–and specifically the number for Behavioral Health Services (if there is one on your card)
    1. Before you get started, be sure to have a paper and pen ready to write down information that your insurance company’s Customer Service department provides. This will save you a headache later.
    2. Look on your insurance card to locate a phone number specifically for behavioral health or mental health benefits (it is often on the back of the card).
    3. Call that phone number or Customer Service if you do not have a specific mental health/behavioral health number listed on your card. (I suggest that you avoid locating information from a website as each plan is different and website information may be more general).
    4. You will be asked to provide your name and Subscriber ID (located on your insurance card). Please note: if your insurance is through your spouse or partner’s employment, then he or she is the Subscriber.
  2. Verify if you have an outpatient mental health benefit. It is also often referred to as “Behavioral Health”.  Ask how many sessions you are allowed each year and verify your co-pay amount.  The co-pay is the amount you pay to your provider at the time of service.
  3. Understand how your deductible works, if you have one.
    1. Ask if you have a deductible for your mental health (or “behavioral” health).
    2. Some plans may waive the deductible for certain types of medical care.
    3.  If so, find out how much your deductible is, and has it been satisfied for the year?
  4. Ask if Kim Roser-Kedward, LCSW is a provider (“in network”) on your particular plan.  If they have trouble locating me, give them my Tax ID #20-3227535.
  5. If I am not an “in-network” provider for your plan, then ask if you have “out of network” benefits or coverage (and find out what it is). Be sure to carefully write down the details.
  6. Ask if a “pre-authorization” is required.  If so, ask for an authorization to meet with Kim Roser-Kedward, LCSW and write down the authorization number they give you. If pre-authorization is required, I will need the authorization number before I can meet with you.
  7. Please feel free to phone me at 619-379-7450 with any questions or if you have any difficulties obtaining your insurance information. I will be happy to try to help you. Please leave a detailed message, as I do not answer the phone while I am in appointments with clients.