The Attachment Institute of New England
Rebuilding Broken Bonds

Insurance


Payment for therapeutic sessions is available through a variety of insurance companies and local assistance groups can help with appeals to insurance companies. Researching resources in the state you live in, as well as working with your insurance company, are worth the time and effort. Keep detailed logs of whom you speak with: date, time, and their specific contact information. (Phone number, email address, etc,) When speaking with them, use them as resources as well, to obtain contact names of others who may be able to help.

You may want to download this client sample letter (in Microsoft Word format) which can be useful when contacting an insurance company for out of network consideration. Also, click here to download a sample thank you letter to those who have helped; this is important, as you may need their assistance again.

Many insurance companies are familiar with our work and as a result have developed standard protocols to follow for authorization. Some companies can be more difficult to navigate and the following techniques may be useful in working towards authorization. Most importantly, do not be discouraged, and feel free to call us with questions and concerns you have regarding your specific insurance plan.

You will want to familiarize yourself with the Parity Laws.


Massachusetts

Option 1: Request Out of Network Authorization from your Insurance

If the clinician most suited for you is not in your insurance network, the Managed Care Reform Act requires most Massachusetts managed care and insurance companies to provide adequate access to “all mandated provider types” (e.g. psychiatrists and psychologists); a full range of mandated services including specific treatment modalities appropriate for all ages of patients and all types of covered mental conditions; and there are sufficient number of providers available in the network so that no patient must wait a medically inappropriate amount of time to receive care of acute conditions.

If you believe your network is not complying with the law you may insist that they provide a single case agreement for the clinician you believe can meet your needs. Typically, you must be prepared to convince them that you tried and failed to find a clinician within your area, who has the expertise and training, and is in your network before they will give an out of network authorization.

The tax ID for The Attachment Institute of New England, Inc. is 043708585. If you do receive out of network authorization, make sure it is for the full rates. Insurance companies often approve authorizations at their discounted rates, which may be 50% less than the clinician's fee. Our practice does not accept discounted rates.

Please have them fax the agreement to 508-753-9779 to the attention of Jen Kelleher.
If they refuse, you may want to inform them that you believe they may be breaching their contract with you. You may request to speak with a supervisor. Let them know if you plan to notify the Bureau of Managed Care and your employer's human resources department.


Option 2: Internal appeal

If a request for insurance coverage is rejected, an appeal is indicated. The appeal should include:
  • an appeal letter
  • a letter from a clinician or specialist addressing specific needs for treatment
  • information pertinent to the appeal, such as previous residential placements and failed therapeutic processes
The appeal letter should include:
  • your policy id numbers
  • a brief history of the illness and necessary treatment
  • what you are asking the insurance company to provide
  • state why you believe the denial is wrong
  • a request for a more detailed reason for the denial*
  • a request for the file from the insurance company*
    * these may be helpful if an external appeal is necessary


Option 3: Contact the Bureau of Managed Care

http://www.mass.gov/doi/Managed_Care_home.html
Phone: 617-521-7372
Fax: 617-521-7773
Email: bmc.mailbox@state.ma.us


Option 4: Contact the Human Resources Department of the Employer Providing Health Coverage

Inform them that you are unable to find appropriate care within the network, unable to obtain an out of network authorization, and request their help. The employer is the 'customer' who the insurers want to please. When they contact the sales department at the managed care company they are usually successful at obtaining authorization.


Option 5: Request Help from Mental Health Legal Advisors

Contact Susan Fendall, at the state's Mental Health Legal Advisors
Phone: 617-338-2345
Email: sfendell@email.mhl.state.ma.us


Option 6: Request Help from Health Law Advocates (HLA)

HLA represents low income ($60,000/year for family of four) Massachusetts residents denied access to health care.
Phone: 617-338-5241


Option 7: File a Complaint with the Massachusetts Division of Insurances

http://www.mass.gov/Eoca/docs//doi/Consumer/css_complaint_form.PDF


Option 8: Contact Lawmakers

Let the lawmakers know that the law is not being followed and request action

Representative Ruth Balser, Ph.D.
Co-Chair Joint Committee on Mental Health and Substance Abuse
State House, Room 33
Boston, MA 02133
Phone: 617-722-2060
Fax: 617-722-2850
Email: Rep.RuthBalser@hou.state.ma.us

Senator Steven Tolman
State House
Room 511-B
Boston, MA 02133
Phone: 617-722-1280
Fax: 617-722-1069
Email: Steven.Tolman@state.ma.us

Julie M. Bowler
Commissioner of the Massachusetts Division of Insurance
Fax: 617-973-8798

Director, Office of Patient Protection:
Fax: 617-624-5046


Connecticut

Option 1: Request Out of Network Authorization from your Insurance

Contact your insurance company to see how to go about requesting out of network authorization. The tax ID for The Attachment Institute of New England, Inc. is 043708585. If you do receive out of network authorization, make sure it is for the full rates. Insurance companies often approve authorizations at their discounted rates, which may be 50% less than the clinician's fee. Our practice does not accept discounted rates.
Please have them fax the agreement to 508-753-9779 to the attention of Jen Kelleher.


Option 2: Internal appeal

If a request for insurance coverage is rejected, an appeal is indicated. The appeal should include:
  • an appeal letter
  • a letter from a clinician or specialist addressing specific needs for treatment
  • information pertinent to the appeal, such as previous residential placements and failed therapeutic processes
The appeal letter should include:
  • your policy id numbers
  • a brief history of the illness and necessary treatment
  • what you are asking the insurance company to provide
  • state why you believe the denial is wrong
  • a request for a more detailed reason for the denial*
  • a request for the file from the insurance company*
    * these may be helpful if an external appeal is necessary


Option 3: Contact the Human Resources Department of the Employer Providing Health Coverage
Inform them that you are unable to find appropriate care within the network, unable to obtain an out of network authorization, and request their help. The employer is the 'customer' who the insurers want to please. When they contact the sales department at the managed care company they are usually successful at obtaining authorization


Option 4: Contact the Office of the Healthcare Advocate

P.O. Box 1543
Hartford, CT, 06144
Phone: (Toll Free) 1-866-HMO-4446
Fax: 860-297-3992
Web Site: http://www.ct.gov/oha/site/default.asp
Information at this site explains internal versus external appeal processes
Email: Healthcare.advocate@ct.gov


Option 5: Contact the Connecticut Insurance Department

P.O Box 816
Hartford, CT 06142
Phones: 860-297-3800 860-203-3447
Fax: 860-566-7410
Web Site: http://www.ct.gov/cid/site/default.asp
Consumer services:
Click on the Consumers button which has a How-to Guides section.

Option 6: Contact The Office of the Child Advocate
999 Asylum Avenue, 1st Floor
Hartford, CT 06105
Phone: 860-566-2106
Toll Free: 1-800-994-0939
Fax: 860-566-2251
Web Site: http://www.ct.gov/oca/site/default.asp