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We provide consultation, psychotherapy & reduce symptoms of psychiatric disorders in geriatric, care center, nursing home, home residence and as outpatient basis.
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Insurance Medicare and Developmentally Disabled
Our Service accepts Medicare Part B insurance coverage. We accept “Medicare Assignment” which means the fees we charge are set by Medicare. Medicare Part B generally pays 50-80% of the Medicare-approved amount for covered services received after a $110 deductible is met. The beneficiary is responsible for the deductible and the other 20% in many other practices is charged but not charged in ours. In some cases private insurance is utilized to pay the deductible and remaining 20% so it may not be an issue at all. This type of medical insurance is referred to as “supplemental coverage.” For Senior Citizen & Caregiver Info.
We have a long standing with AARP and are happy to accept it. You have questions about coverage and our services please contact us. Sometimes it is in your benefit to pay us directly not thru your insurance you in turn get paid by them. An example would be some retirement or federal employee programs, and railroad employees. Whatever your financial situation we are willing to discuss how we may help. Don’t underestimate the developmentally disabled.
Enrollment in Medicare Part B
To enroll in Medicare Part B, the individual must file an application with the Social Security Administration during the initial enrollment period. This is a seven-month period that starts three months prior to the month the beneficiary first meets the Medicare requirements. For more information, visit Medicare Basics. For any other questions contact us by phone or the forms available on the Contact or Home page. Read Medicare and Your Mental Health Booklet online.
Intellectual Limits Developmentally Disabled Psychotherapy Counseling
Developmentally disabled persons have particular eligibility when it comes to Medicare Part B and our services. Some are limitations dictated by Medicare Part B; such as that the developmental condition must be mild to moderate and psychotherapy counseling must do some good. The service is directly to the Medicare beneficiary and sometimes their family just as any other beneficiary. It should be noted that even though this is a service it may be the only time the beneficiary has had a relationship with someone in confidence.
For this purpose autism falls under the broad category of developmental disabled. Policy reads,”Individual and group psychotherapy services are not considered medically necessary for the patient with severe or profound mental retardation (ICD-9-CM codes 318.1, 318.2, and 319). Severe mental retardation is defined as an IQ 20-34 and profound mental retardation is defined as an IQ under 20. These services are not considered medically necessary if a review of medical records indicates that dementia (organic brain syndrome) and Alzheimer's Disease (ICD-9-CM codes, 290.0-290.9, 331.0-331.2) have produced a severe enough cognitive defect to prevent psychotherapy from being effective.” Policy source online
Family of developmentally disabled, I may give an option to receive some treatment counseling under the Medicare Part B of the developmentally disabled person. Medicare Part B allows for behavioral work such as this just so that makes it feasible and practical to avoid re-hospitalization and re-institutionalization and that it be focused on the developmentally disabled person.
For this purpose autism falls under the broad category of developmental disabled. Policy reads,”Individual and group psychotherapy services are not considered medically necessary for the patient with severe or profound mental retardation (ICD-9-CM codes 318.1, 318.2, and 319). Severe mental retardation is defined as an IQ 20-34 and profound mental retardation is defined as an IQ under 20. These services are not considered medically necessary if a review of medical records indicates that dementia (organic brain syndrome) and Alzheimer's Disease (ICD-9-CM codes, 290.0-290.9, 331.0-331.2) have produced a severe enough cognitive defect to prevent psychotherapy from being effective.” Policy source online
Family of developmentally disabled, I may give an option to receive some treatment counseling under the Medicare Part B of the developmentally disabled person. Medicare Part B allows for behavioral work such as this just so that makes it feasible and practical to avoid re-hospitalization and re-institutionalization and that it be focused on the developmentally disabled person.
Coaching The Developmentally Disabled
Coaching is not covered under insurance because it’s an education and development function of helping. But its more guidance than mental health. We sometimes find the developmentally disabled underestimated in the functions they can perform as opposed to people with similar education and background. Its very difficult to navigate the competitive world for all of us, and all of us need coaching at some point. Do not hesitate to call us.
