Is it normal for insurance companies to request a treatment plan for a member you provide services to?

[deleted1129370]

I got a voice message from a BCBS RN case manager requesting a treatment plan from me for a member of theirs I see. Is this typical? What should I expect? What do you do?

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[psych.meout]

I'm on internship at an AMC in a large health system and we need to have treatment plans for every therapy patient and they need to be reviewed and updated at least every 90 days.

 

[deleted1129370]

Yes, I do treatment plans routinely and that's not the issue at hand tho. I am curious to see what others have done when approached by an insurance company requesting said treatment plan. Are they looking for something in particular, are they looking to claw back money, etc.

 

[WisNeuro]

Yes, I do treatment plans routinely and that's not the issue at hand tho. I am curious to see what others have done when approached by an insurance company requesting said treatment plan. Are they looking for something in particular, are they looking to claw back money, etc.

If you don't meet their documentation standards, they can.

 

[AcronymAllergy]

I can only answer based on second-hand knowledge, as I currently don't provide insurance-based therapy. I don't know if I'd say it's typical, but it's not atypical, at least from what I've heard.

 

[deleted1129370]

So some things stand out to me about what has come up. The person who called me evidently called me via Psychology Today as I received a notification from PT that "Blue Cross Blue" had called me. The person left a number to call back that was not the number they called me from, so, when I called it, the voice recording said "you have called Blue Cross and Blue Shield Managed Care, please enter the 5 digit extension of the care provider you wish to reach."

After finally getting ahold of the supposed case manager, the person told me they were looking for me to send them a single treatment plan for a patient I have and they did indeed name the person's name. I advised them I didn't have a fax machine, so they said I could email it to them. They asked me for my email (which I found odd as BCBS should have this info on file already). When I further inquired as to if they will send me an email that is encrypted they started "I was going to email you from my company email." So that was odd. Needless to say, I have yet to receive an email from them.

They mentioned this was just to find out if the member is receiving all the healthcare services they are entitled to or would benefit from, and that this was not an audit, nor would this be a situation where they would want me to modify anything in terms of my documentation.

 

[msc545]

It is normal. Make it concise and minimal.

 

[Peacemaker36]

If you don't meet their documentation standards, they can.

Yes, I believe the purpose is to find out if they can clawback previous payments or refuse future payments.

 

[PsyDr]

It is normal. Make it concise and minimal.

If you’re going back 9 months: you made an unsupported assertion, and I asked you for evidence of that position. You could finally answer that.

 

[Sanman]

Yes, I believe the purpose is to find out if they can clawback previous payments or refuse future payments.

I mean that is pretty much always their purpose because that is what they do, manage the parameters and limitations on care to "save" money. It's not like insurance companies make social calls. Either it is covered under their contract or not.

 

[msc545]

If you’re going back 9 months: you made an unsupported assertion, and I asked you for evidence of that position. You could finally answer that.

The content of this is not the problem. The problem is your imperious style of asking, which I have no intention of reinforcing or rewarding. Repeatedly asking and demanding will not achieve your goal.

 

[PsyDr]

The content of this is not the problem. The problem is your imperious style of asking, which I have no intention of reinforcing or rewarding. Repeatedly asking and demanding will not achieve your goal.

I don’t know. It seems to meet my goal of pointing out that you make statements without any evidence or willingness to back it up.

 

[msc545]

I don’t know. It seems to meet my goal of pointing out that you make statements without any evidence or willingness to back it up.

Your opinion in this matter is worthless and also vindictive. Go away.

 

[AcronymAllergy]

Mod Note: Let's try to remain on topic with the OP, folks. Thanks.

 

[borne_before]

If you get a board complaint, they will love that you actually have a formal and signed tx plan. I should probably be better about mine.

 

[docloufan]

Yes, I believe the purpose is to find out if they can clawback previous payments or refuse future payments.

The purpose it to ensure that a product you are paying for is producing, or likely to produce, some kind of tangible benefit and adheres to the standard of care/best practices of the profession. Seems very simple and reasonable to me.

 

[Sanman]

The purpose it to ensure that a product you are paying for is producing, or likely to produce, some kind of tangible benefit and adheres to the standard of care/best practices of the profession. Seems very simple and reasonable to me.

If that was the purpose, they would require it at or prior to the time of services rendered. Standard of care is also anything but standard. Each insurer has slightly different standards as to what services qualify for what reimbursements. Try getting a clear cut answer about which services qualify for 90834 vs 90837. When I have attempted to obtain such information, they are anything but straight forward.

 

[docloufan]

If that was the purpose, they would require it at or prior to the time of services rendered. Standard of care is also anything but standard. Each insurer has slightly different standards as to what services qualify for what reimbursements. Try getting a clear cut answer about which services qualify for 90834 vs 90837. When I have attempted to obtain such information, they are anything but straight forward.

I think you are overthinking it. Treatment plan are universally considered best practice and standard of care. If you dont have one for your patient, its a problem. The insurer has every right, per the contract you agreed to, see the quality and progress of work they are paying for.

 

[Sanman]

I think you are overthinking it. Treatment plan are universally considered best practice and standard of care. If you dont have one for your patient, its a problem. The insurer has every right, per the contract you agreed to, see the quality and progress of work they are paying for.

I don't disagree that they are a best practice and standard of care (as I am in the middle of writing one as we speak). I am saying that the reason an insurer calling about one, especially if it is well after treatment and out of the blue, may suggest that they are looking to audit the case. If it is earlier in the process, it is usually more routine part of authorization.

 

[Therapist4Chnge]

I learned very early to know and apply the documentation requirements for Medicare to every clinical report I write. They tend to cover 95% of what insurers will ask about. Insurance companies loooooove to try and clawback $$ for BS reasons.

Including a treatment plan should be in note 1-2, as it is what should guide treatment. They can be general like “Teach coping skills to help better manage stress.” If you really want to get a gold star, you can add a line to the treatment plan specifying an example, but I usually just put those in the body of my note and kept my treatment plan/goals and recs uncluttered.

 

[psych.meout]

Thinking that insurers care about best practices (as opposed to cheapest practices) is incredibly naive.

 

[msc545]

Thinking that insurers care about best practices (as opposed to cheapest practices) is incredibly naive.

Exactly. Everything they do is about saving themselves money, and they only worry about quality of care secondarily, if ever. Welcome to Healthcare in the US.

 

[smalltownpsych]

A separate treatment plan document was not standard of care when I was trained but agencies really like documentation so it became one, I do one just in case some agency looks at my documentation down the road but that it is the extent of its utility so I don’t put a lot of effort into it.