After systematically analyzing the challenges and benefits of meeting the demands of insurance companies and accepting their low reimbursement rates, my consultants and I have concluded that EFC will not survive as a business if we continue to operate in the current insurance-based model. This conclusion left me with two options: 1] discontinue EFC’s relationships with insurance companies, or 2] permanently close our doors. After careful and heart-felt consideration of these two options, I chose option # 1; consequently, EFC will withdraw from all insurance panels and will no longer accept or file insurance effective November 16, 2021. I avoided making this difficult decision for several years because, I and the EFC staff did not want to disrupt the relationships we have with our clients. We are grateful for you and for your trust in us. Many behavioral health care providers are leaving the profession or no longer accept insurance because of the difficulties they encounter when dealing with insurance. For example, over 48% of the psychiatrists in this country no longer take insurance for the same reasons we were forced to make this difficult decision. We want to maintain our relationship with you. We certainly understand that not using your insurance will be a burden for many of you and that some of you will need to seek behavioral healthcare services from providers who accept insurance. Regardless of your choice to stay with EFC or to seek services elsewhere, we are committed to making your transition to either as easy as possible for you. We will continue to process your claims for our services with your insurance company for three (3) months. Beyond that time, we will no longer accept insurance.
Information for Clients Who Choose to Stay with EFC
Full payment is due at the time of service. We will provide you with the specifically designed receipt which includes everything required by insurers to reimburse their members who see providers who are not in their network (an “out of network” provider).
If your insurance plan/policy includes out of network benefits, you can request reimbursement which should allow you to receive a full or a partial refund for the amount you paid us, based on your own insurance coverage. Check with your insurance company to see if your policy includes “out of network benefits” and what those benefits are. In the near future, you will receive another email that will include a list of private pay rates for all of our clinical services, and the discounted rates we are offering our existing clients.
Information for Clients Who Choose to Seek Other Providers
For those of you who choose to seek care elsewhere, this three-month notice provides ample time for you to find a new provider who takes your insurance. Because so many providers no longer take insurance, we recommend you initiate your search for a new provider within the next couple of weeks.
Suggestions To Assist You In Your Search For A New Provider:
- Check with your current insurance company for a list of behavioral healthcare providers who take your insurance.
- Call the providers’ offices to verify if the information you were provided is correct (Occasionally, insurance companies fail to remove providers from their lists following their departure from the insurance panel of providers, due to their retirement, death, disability, relocation to another state, etc.)
- When you call the provider’s office, inquire if the provider is taking new clients. If the provider is not taking new clients, inquire about getting on their waiting list and/or continue your search.
- When you identify a provider who accepts your insurance and is accepting new clients, immediately schedule an appointment with that provider well in the future.
- Once you have confirmed an appointment date with a new provider, email our office the name, address and phone # of the provider along with the date of your initial appointment. Upon the receipt of your email with this information, we will email you a Release of Information Form with instructions for completing the form. Complete the form as instructed, sign and return to our office.
- Once we receive your properly executed release form, we will forward your EFC treatment records to your new provider.
If interested, here is additional information about why EFC will stop accepting insurance.
Although our clients are experiencing a steady increase in the cost of their monthly health insurance premiums, the rates at which insurance companies reimburse behavioral healthcare providers have significantly declined.
As our reimbursement rates have declined, the “hidden” costs of doing business with insurance companies have increased exponentially. For example, we have had to hire additional administrative staff to:
- Verify insurance coverage for each client
- Obtain preauthorization before treating a client
- File insurance claims
- Follow up on claim denials
- Obtain preauthorization for many prescriptions
- Prepare written justification for medications needed by a client
In addition to having to jump through these costly administrative hoops, an increasing number of insurance companies now require providers to submit an endless amount of paperwork (which often contains confidential client information) to justify a client’s need for treatment before the company will remit payment. This occurs after treatment was already pre-authorized, and pre-authorization is already completed prior to initiating treatment with the client. EFC’s entire staff and I are grateful for the opportunity you extended to us to provide behavioral healthcare services to you and your loved ones. It has been a privilege and a pleasure for EFC’s providers, administrative staff and for me. Gratefully yours,