More Healthcare Insurance Fraud in Connecticut!

My friend, S, shared a story with me the other day of her visit to a LCSW therapist who performs neurofeedback in Ct..

 Ok…interesting enough in itself that the LCSW can charge my friend S’s insurance for neurofeedback as it falls under “20 pass thru sessions” that require little documentation…more interesting is that the LCSW told her she would be billing her insurance company under the DSM code for an “adjustment disorder” — after talking with her for 20 minutes….and even more interesting is, that this LCSW told my friend S. that she would have to bill her insurance for two sessions (each visit), as one session didn’t come close to paying for her $175/hr fee!

I carefully explained to my friend S. how Mental Health Practitioners theoretically “sign a deal with the devil” in accepting insurance coverage, but nevertheless in entering a contract with an insurance company the therapist agrees to accept “the contracted amount ( plus clients copay)….period!  My friend was rather suprised to realize that this is insurance fraud and thought it was “normal” for the LCSW to want to cover her “regular” fee.

Yikes people! Please wake up! Just because it’s only costing you your copay doesn’t mean fraud is ok! Plus…if you have 20 “pass thru” sessions and the therapist bills double for the first 10 …you are screwed on the 11th….in the middle of “the work” and perhaps stuck paying cash, as the LCSW might have difficulty substantiating  further treatment.

Good news is that S. didn’t respond well to the neurofeedback (said she felt very disoriented and dissociative for several hours afterward ), and the LCSW  basically evaded her questions, so she will not be returning for futher “treatment”.

As much as I wanted to ask the therapist’s name and then do some investigation of my own… aka. “set her up” …I did not…but I think about it!

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3 Responses

  1. <>

    This kind of fraud needs to be stopped. It will only stop when patients report such fraudulent therapist to the insurance company and the licensing board and then insist on accountability.

    • Hi John!

      You know my experience….between the therapist, the Ct. Department of Public Health and Anthem Insurance ( Ct Dept of Insurance is still in question) I have found zero accountablity on any level. Reporting fraud to an insurance company does nothing for the consumer, and only guarantees the insurance company gets it’s money returned! Licensing boards are full of “foxes (pl?) that are guarding the chicken coop” and serve to protect income to their respective states coffers.
      So where do we start enforcing existing laws and standards??? No one really wants to know about fraud unless it’s millions of $$$ that make the headlines, and can promote the career and bloat the ego of some fat cat politician or attorney.
      You can knock on the door…and I promise you no one is home!

  2. […] This post was mentioned on Twitter by Dana Brook, Dana Brook. Dana Brook said: More Insurance Fraud in Connecticut!: http://t.co/m3nZBOW […]

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