OCD TREATMENT IS AFFORDABLE:

The good news is that treatment for OCD is more affordable than ever before.  Most clients' insurance reimburses them for the vast majority of my fee and offer a generous number of sessions.  Even better news is that due to a new law, called Timothy's law, requires insurance to cover treatment for OCD and anxiety at a higher rate (as much as 80%) and usually for more or unlimited sessions.  So going out of network isn't as expensive as it used to be.  In fact, even if you have an HMO or Medicaid with no out-of-network coverage, I will fight for your right to coverage of the treatment you deserve!

We negotiate with your insurance to cover OCD therapy.  You focus on getting better!  No one else fights to get you covered like we do.

I  WILL  NEGOTIATE  WITH  YOUR  INSURANCE  TO  COVER  ME:

I will negotiate with your insurance to cover me even if I'm not in their network.  For decades I've made specialized OCD treatment accessible for hundreds of clients regardless of their insurance policy and financial resources.  Other therapists just don't do this.  I am often successful in negotiating with HMOs, EPOs, and Medicaid (Fidelis, Amerigroup, HealthPlus, Horizon, Blue Cross, United Health Care, Optum, Oxford, GHI, Cigna, Aetna, etc.) to cover me as if I'm in-network.  If successful, that means you would still pay me my same full fee of $180 at each appointment, but I give you a receipt, and your insurance refunds you 40-80% (except your standard copay and/or any in-network deductible).  As with all providers, clients are responsible to ensure the provider is paid in full and to keep track of deadlines for renewal of their insurance authorization.  It's not a guarantee, it takes a month to get a decision and definitely involves some hassle on the client's part, but it costs nothing to try and is often successful.  It requires you to start the process.  Please follow the instructions below exactly as they are written.

One call from you is all it takes to get started.   Then, we take over from there and make a case on your behalf to get a single case agreement.

1.    Please call your insurance company's member services department (on your insurance card) and tell them: “I am seeking a ‘single case agreement’ to cover an out-of-network psychologist who's treating me for OCD.” (Sometimes it might be called an "ad hoc agreement" or "exception authorization" or "exception accommodation.")

2. They might transfer you to an “intake” person or "care advocate" who will just take down basic facts.  Always get the names of all people you talked to and a reference number or case number they use to retrieve notes from your conversation.  That might be important as insurance companies have a funny habit of "forgetting" what they promised you.

Tell them the following:

a. “I am seeking a ‘single case agreement’ to cover services of an out-of-network psychologist I am seeing. I need a male psychologist in my area who treats OCD with exposure response prevention (ERP), and who can provide therapy outside of his office, and I called all the providers on the list and none fit this description.” (If you wish to tell them that you want “a therapist who is religious,” which I happen to be, it will greatly improve your chances; you don’t have to justify why.  You don't have to state your religion or mine.  If they say you can't choose the religion of your therapist, just say you want someone "initimately familiar" with your religion or values.)

b. Emphasize that “exposure response prevention is the only therapy recommended by the International OCD Foundation," and the Expert Consensus Protocol for OCD Treatment.

c. Ask them to call Dr. Brodsky at 212-726-2390 "to negotiate a fee" and cover his services.  Usually, they will just take the facts; they won't argue with you. Before you hang up, get their name and a “reference number” or "case number" for your discussion.   This will ensure they approve coverage retroactive to that date.  If they won't call me, get a direct number or extension for me to call, and ask if I can fax or email the request instead of calling.  A fax number or email address will greatly speed up the process. If you can't get that, at least get the number for their "Behavioral Health" division.

When you call, a care advocate will just take a few notes; they won't argue with you.

3.     Usually they tell you they will send your case to a “care manager” or “care advocate” or “utilization manager” who conducts a “clinical review” of your case.  Next, the care manager will talk to me to get further details to justify “medical necessity”, that is, that I'm the only OCD therapist who satisfies all your requirements.

Make sure to have these instructions visible when you call.  Follow them exactly.

4.     If they give you a hard time, which is very rare:

a.     Ask to speak to a supervisor if the person you are speaking with can’t help you.  If that doesn't work, just hang up and call again.  You'll get a different person and probably a different answer.

b.     If they say you can’t specify religion, which is highly unlikely, you can still tell them you only feel comfortable with someone who is religious in general, or who is knowledgable about your faith and you felt the other therapists challenged your faith values.

c.     You can prove the necessity of ERP by showing them supportive professional documents we'll provide.  Or I can do it for you.

d.     Your insurance might send you a list of in-network therapists to call first before authorizing me to treat you.  Remember every therapist in the world tells insurance companies that they treat OCD (and everything else under the sun), but they're not at all competent.  Just call your insurance back the next day and tell them you called everyone on their list and they either don't do ERP, don't specialize in OCD, hoarding, or panic, aren't male, made you uncomfortable religiously, challenged your beliefs or values, are too far away, weren't willing to do therapy outside of their office if needed, aren't taking new clients, or didn't return your call. 

No one fights harder for you to get coverage for the treatment you deserve.

5.     Bottom line, keep calm but don’t take no for an answer.  If they ever give you a hard time, remind them:  “You are legally required to cover appropriate treatment of my condition (even if they are an HMO), and must make alternate arrangements if your providers can’t treat me.”  If you have out-of-network coverage, and they tell you to see me at the out-of-network rate, tell them it's still unaffordable.  

Keep calm.  You have a legal right to coverage, even if it's out of your insurance network.

Note that insurers are obligated to provide adequate care for everything.  When they offer out-of-network coverage, they charge a hefty fee to accommodate a patients' preferences and freedom of choice because patients "like" their old doctor and don't want to change providers when they get a new plan.  So out-of-network providers are essentially a luxury to substitute for an existing in-network provider.  However, insurers are not off the hook if they totally lack any competent in-network provider.  That would mean you're really not insured and would be forced to go out-of-network.  So insurers are still obligated to provide coverage of my services at an in-network rate.

We're usually successful.  Occasionally there is an initial negative decision, but we'll appeal your insurance company multiple times and are often successful in getting authorization for therapy.

6.      If they finally deny your request in writing, we may appeal their decision twice.  We won't stop fighting for you.  We write detailed reports and speak to multiple staff to get your coverage authorized.  In the interim, if you prefer to start therapy anyway and don't want to wait, if they finally authorize coverage, they usually authorize it retroactively to when you called or often even your first appointment.

For details, email a question or request a free consultation within 24 hours.  If you don't want to wait for authorization and are ready to start, you can make an appointment online now or call 212-726-2390.  Virtual teletherapy and in-person appointments are available nationwide in 42 states for OCD from Huntsville, Alabama to Detroit, Michigan.