Therapist Network Nightmare
Your insurance company has abruptly changed networks, forcing you to abandon your trusted therapist of three years. With only two weeks of medication left and worsening anxiety symptoms, you must navigate a labyrinth of bureaucracy to either maintain continuity of care or find a new in-network provider. Time and emotional resources are running out.
Challenges
0
Survivors
0
Popularity
0
Difficulty
B1-B2
Scenario Overview
Your Role
Long-term therapy patient with anxiety disorder
Conversation Partner
Ms. Thorne, Insurance Network Operations Manager
Setting
Stark corporate office bathed in fluorescent light, walls lined with compliance posters and pharmaceutical ads
Location
Wellmark Insurance Regional Office, Claims Department
Learning Objectives
Secure a continuity of care exception or expedited transfer
Obtain documentation of medical necessity from current therapist
Navigate insurance approval process without emotional breakdown
About This Scenario
Your insurance company has abruptly changed networks, forcing you to abandon your trusted therapist of three years. With only two weeks of medication left and worsening anxiety symptoms, you must navigate a labyrinth of bureaucracy to either maintain continuity of care or find a new in-network provider. Time and emotional resources are running out.
How It Starts
“I see you're inquiring about an out-of-network exception for Dr. Sanders. Unfortunately, as per policy GL-2023-447, your plan no longer covers services with that provider. I can offer you a list of in-network alternatives within our new Preferred Provider Organization. Shall we proceed with that?”
This is how Ms. Thorne, Insurance Network Operations Manager's greeting will start.
Practice Details
Scenario ID
#616
Category
General
Location Tag
Wellmark Insurance Regional Office, Claims Department
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