ATTENTION HORIZON PATIENTS
On occasion, some of the insurance claims for our Advanced Practice Nurses have been denied due to their affiliation with other institutions. You should be aware that this could affect your visits with Advanced Behavioral Counseling not being reimbursed.
This “issue,” exists because practitioners are also employed by other organizations/practices in addition to Advanced Behavioral Counseling. These other employers have them listed as “in network” with Horizon, and therefore Horizon will not allow them to participate as an “out of network” provider within their personal private practice.
Advanced Behavioral Counseling (like many small practices) choose to remain “out of network,” and are only “in network” with Federal Medicare.
The issue is that you, as a consumer of Horizon’s insurance plan, may be paying for “out of network” benefits/coverage, but Horizon is limiting which “out of network” providers they will reimburse you to see. We see this action with Horizon, as an attempt to block a consumer’s access to care.
Access to care is defined as, "the timely use of personal health services to achieve the best health outcomes."
This unfortunately, is not illegal, but unreasonable and unethical. Additionally, this rule does not apply to all providers across the board depending on where they work, as well as what type of provider they are. Small independent practices, like Advanced Behavioral Counseling are discriminated against. This Horizon practice limits your freedom of choice when choosing a provider.
We ask that you contact your insurance company prior to your appointment discuss this issue for benefit coverage.
If you would like to continue to see your preferred provider, payment will be requested at the time services are rendered. As a courtesy, we will submit the bill to your insurance company (Horizon). If claims are denied, you will be responsible for payment.
Our consultation fees are $350 for first visits, and $175 for follow up appointments.
We hope you understand the dilemma that Insurance Companies place on consumers access to quality care provided at our office. Please be wise and become an educated consumer.