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Counseling HMO Insurance Worksheet Mobile App

The Counseling HMO Insurance Worksheet app was developed for psychologists, counselors and therapists. The app makes it easy for patients and therapists to complete a Counseling HMO Insurance Worksheet using a smartphone or tablet. It is simple to ensure patient privacy by making this app HIPAA compliant. Your GoCanvas log in is the same for the GoCanvas Website and your Mobile Device log in.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

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Take a peek inside the Counseling HMO Insurance Worksheet Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Client Name:

  • Ico textbox

    Parent Name: (if child is client)

  • Ico statictext

    Insurance Information:

  • Ico statictext

    Please phone your Insurance Company and fill out this form the best you can.

  • Ico statictext

    This is very helpful information if you are unfamiliar with your coverage

  • Ico textbox

    Name of Insurance:

  • Ico textbox

    Phone:

  • Ico textbox

    Claims Address:

  • Ico textbox

    Insured’s Name:

  • Ico textbox

    ID #:

  • Ico textbox

    Plan/Grp #:

  • Ico statictext

    When you call, be sure to write down the name of the person that you talk to for later reference.

  • Ico textbox

    HMO Contact Person:

  • Ico date

    Date:

  • Ico time

    Time of call

  • Ico statictext

    Say, “I’m calling to clarify my benefits and coverage for out-patient mental health.

  • Ico statictext

    Ask enough questions to complete all of the information.

  • Ico textbox

    Is my therapist

  • Ico statictext

    (Name your therapist; you may find that information on your insurance’s website, but do remember ...

  • Ico textbox

    If

  • Ico statictext

    is NOT on their panel, then ask these questions:

  • Ico checkbox

    “Does my policy allow me to choose my own therapist?

  • Ico checkbox

    “Can I go outside of the panel or the provider list?

  • Ico multiline

    (If so, “Is my coverage different?

  • Ico statictext

    Then ask: “What is my:

  • Ico textbox

    Copay: per session

  • Ico date

    Effective Date of Policy:

  • Ico checkbox

    Deductible?

  • ...and More!

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