Fees and Insurance
Most psychotherapy services in Kansas are covered by health insurance. However, you may have to call the number on the back of your insurance card to get prior authorization. Family Psychological Services directly bills most insurance plans. Other plans allow out-of-network benefits. Please contact your health insurance providers to find out the details of your coverage. Copay, deductible, coinsurance and any other services not covered by your insurance, must be paid at time of service via a credit card on file or on a payment plan, as described below. Due to restrictive Medicare billing policies and auditing procedures, we only serve Medicare patients within scope of practice on an "opt-out" cash only basis.
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Sheiled of KC PPO (Not HMO)**
All KanCare Plans
Cigna Behavioral Health Care
United Health Care (via Optima)*
Aetna (including former Coventry)
Century Health Solutions
Most others out of network
*Dr. Wes and Adrian Zelvy do not see United Health/Optima clients in-network. This means that the client pays a rate at time of service (set to the allowable charge for BCBS of Kansas for each provider), signs a document for United Healthcare, and FPS submits that document along with a receipt to United. United them sends a check for some percentage of that amount directly to the client OR applies the full amount to the deductable, depending on the plan.
**Note that BCBS of Kansas City recently took the unprecidented step of no longer paying office visits for psychotherapy services, meaning that all such services must be paid by the client in full at time of service until the deductible is met. A payment plan that covers 75% of the monthly cost of services may be established with a card on file, which will be billed on a monthly basis until all fees are collected.
You must upload your insurance card before your first appointment or bring it with you and resubmit it anytime your insurance plan/company changes. If you do not, you will be considered a self-paying client until the card can be presented and required ot pay for services at time of delivery.
Carefully Consider Why YOU MIGHT NOT Want to Use Insurance: Today's insurance market is a complex place to do business, whether you are a carrier, a provider like Family Psychological Services, or a beneficiary, like you. Historically in Kansas, insurance carriers were regulated closely by a powerful insurance commissioner who took seriously consumer protection and advocacy. As the political winds have shifted, consumers look closely at their insurance benefits, particularly when used in the highly sensitive area of psychotherapy and psychoharmacology.
Blue Cross Blue Shield of Kansas and Medical Records Auditing. The largest insurer in Kansas, Topeka-based Blue Cross and Blue Shield of Kansas requires full access to members Protected Health Information (PHI) record in order to determine “medical necessity” for treatment. This means that your psychiatric records may be turned over to a company called Verisk for review and auditing. While BCBS follows HIPAA requirements in exempting the “psychotherapy note,” which contains the most private process notes from your psychotherapy, a great deal of information exists there that is required to define medical necessity. It is likely that the insurance carrier, its sub corporation New Directions or Verisk will require more information about your case than you feel comfortable revealing. While BCBS of Kansas holds that this is not a change of policy and all members were signed on to it, the implementation prior to January 1, 2016 required only a routine treatment plan be submitted with goals and objectives. That is no longer their stated policy. FPS has responded to this more extensive auditing procedure by making adjustments to our electronic medical record to both meet the requirements of BCBS and to protect sensitive patient data. However, since we were not apprised of this until October 2015 and BCBS was at one point retroactively auditing records, we cannot assure that your records are protected as psychotherapy notes from that period nor even that they would be in the future.
According to the BCBS KS website, if you have a complaint or are dissatisfied with a denial of coverage for claims under your BCBS Kansas plan, you may be able to appeal or file a grievance. Contact BCBS Customer Service at 1-800-432-3990 or visit www.bcbsks.com/blueaccess, or the Kansas Insurance Department, 420 SW 9th Street, Topeka, Kansas 66612-1678, Phone: 800-432-2484, or visit www.ksinsurance.org, or the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa.
Security of Medical Records. All insurance companies are bound by federal HIPAA laws to protect your health records from improper release. However, a December, 17 2015 news story on NPR found that “Millions of private medical records have been hacked at large insurance companies like Anthem," a company which owns many of the BCBS companies around the United States (but does not own BCBS of Kansas or Kansas City). We have requested information from BCBS of Kansas and New Directions about security procedures and are aware they have hired a cyber security firm to assure your records are protected. However, Family Psychological Services, LLC cannot be responsible for any information once it is released to any insurance company or any use to which that company might submit it. We encourage you to learn more about your insurance company’s policies on these matters, by contacting them directly.
Interest Free Monthly Payment Plans Available. Family Psychological Services is committed to making psychotherapy services affordable. We provide zero-percent financing for copays and coinsurance. All payment plans require an active credit card on file and authorization to bill that number at least once a month for a pre-determined amount. Billing will continue until the balance is paid in full. Hundreds of Dr. Wes' clients have taken advantage of this no-interest financing to make copays and coinsurance affordable.
Relationship (Marital) Therapy, Diagnosis, and Health Insurance Reimbursement: Critically Important Information. There is a long running issue with the validity of insurance reimbursement for relationship and sex therapy. Please review this section carefully if you are seeking these services. Insurance companies will NOT reimburse Family Psychological Services or any other provider for diagnostic codes dealing with relationship or sexual problems because these are not seen as "medically necessary." Services specifically for couples or sex therapy must be paid in cash.
To improve outcomes for the identified individual client, insurance companies usually prefer to have family members involved in conjoint treatment and many require us to document family support in treatment plans, or explain why it is not being utilized. The Family Psychological Services staff strongly prefer to see clients with family members, particularly married or exclusive couples in which one partner has a mental health diagnosis. This is not, however, martial or relationshp. It is what is referred to as a "conjoint therapy process" intended to treat one of the partners for say, anxiety, ADHD, depression, bipolar disorder, etc. Partner participation can provide valuable treatment options, but the chart must be open on the identified and diagnosed client, the partner considered a "collateral" in that process, and the conjoint therapy must address the individual client's treatment goals.
What is NOT covered by insurance is any therapy intended only to address problems in a relationship or any problem that is primarily sexual in nature. If this is your goal in seeking treatment, our staff can provide those services, but only on cash basis.
This is also true of divorce therapy that is not responding to a specific mental health concern. Many times children and adults are having significant mental health problems adjusting to the divorce. Those are reimbursable by insurance because we can show "medical necessity." However, coparenting therapy, supervised therapy with parent and child to reintegrate their relationship, and any forensic service realted to divorce is NOT reimbursable.
To be clear, this is not a policy of Family Psychological Services, but a requirement under all insurance company contracts. Any provider who is billing for a marital-only or sex therapy (as opposed to conjoint services for an identified and properly diagnosed client) is doing so in violation of his or her contract with your insurance carrier, potentially comitting insurance fraud and subject to recoupment. Please feel free to contact our office for more details and to determine if your situation would or would not be billable through insurance.