VHG good practice guidance for requesting additional sessions for BUPA clients

 

Author:	Liz Smith (Senior Counsellor)
Date:	19/02/2024

 

This document outlines some guidance and expectations around good practice when requesting additional sessions/extensions to therapy for BUPA clients on EAP or Connected Care pathways, or discretionary requests to restore sessions for clients who have mitigating circumstances for a DNA/late cancel.

 Contents

1.         Information required in requests and who sees it 2

2.         Turnaround times and setting expectations. 3

3.         Approvals and declines

 

1.    Information required in requests and who sees it.

Putting the right information in your request will assist us to process it more quickly. Requests to extend should be made via the session notes (see image below) and contain the following: 

1.      How many additional sessions you are requesting.

1.      Your clinical rationale for requesting additional sessions.

1.      The benefit to the client of completing additional sessions.
   

If you are not able to request via the session notes, you can email network.clinical@vhg.co.uk with the same information. 

Please be aware that additional session requests cannot be made via a Clinical Note in the Health History on MPB. These are not routinely checked by our clinical team therefore it is unlikely to be picked up and processed if done this way. 

Who sees the requests?

1.      Within VHG, our clinical support team will review the content, ensure the request is appropriate, and process the request by sending it to BUPA.

1.      We send the request to BUPA without any identifying client details, only the BUPA patient number and the VHG client reference.

1.      BUPA may approach the client's employer to approve the funding for additional sessions, but it is BUPA that makes the decision on whether to approve it clinically or not and they do not send the clinical rationale to the employer, so although the employer will be aware that additional sessions have been requested, employers do not have any access to details about the client's therapy or their mental health.
   

 

Therapists will normally receive feedback on extension requests via email and there will be a supervision note added to MPB and session allocations amended if approved.

2.    Turnaround times and setting expectations.

Requests made via session notes on the MPB system are automatically extracted into a list of review requests for our clinical support team. It can take us 48-72hrs to be able to process a request, because we have a large network and there can be high volumes of requests for clinical reviews and extensions to therapy.

BUPA's turnaround time for responding to additional session requests is up to 10 days. VHG staff cannot chase BUPA for a response before that. 

 

Please be aware of this when setting expectations with clients around being able to confirm and book extra sessions. To mitigate potential issues, we suggest the following:

1.      Raising extension requests in good time

1.      Preferably not requesting an extension at the final session, as this can affect the quality of a therapeutic ending.

1.      Making clients aware that there are no guarantees of approval and of turnaround times.
   

     BUPA Connected Care clients, who are referred to VHG for therapy via their own private insurance as an individual policyholder, are responsible for checking with BUPA that they have sufficient cover for the number of sessions needed. These clients may be charged for sessions that are not authorised by their policy, so it is important to advise them to check they have cover in place.

 

3.    Approvals and declines

Most additional session requests are approved, but there are a number of reasons why additional sessions may be declined, either by VHG or by BUPA/employers. 

1.      The request contains insufficient information. If the request does not contain a suggested number of sessions, or there is little or no clinical rationale given, we may come back to a therapist for further information. Even if a client says, for example, they have 20 sessions available on their private insurance policy, we still need to follow good practice in ensuring that the number of sessions offered for a client is decided on via a process of formulation/discussion with a client about their needs and using clinical judgement as opposed to offering a certain number of sessions simply because they are available. 

1.      The request is for a number of sessions that is greater than the client's original offer (EAP). This would not be approved, as an EAP service is designed to be a short term, solution-focused intervention and not long-term counselling. 

1.      The client's employer does not fund additional sessions (EAP). Some employers will offer this option, and some do not have it available (e.g. Macmillan). 

1.      The client has stopped working for their employer (EAP). If a client resigns or their employment is terminated during their therapy, extension requests will not usually be approved by BUPA/employers. An exception to this may be for clients who are made redundant during their therapy - some employers may fund extended sessions to support employees in these circumstances. 

1.      The request is not clinically appropriate to the client's presenting issues. This might include clients who present with significant complexity, trauma, or risk, where their needs may not be best served by a short-term service, and it may be more appropriate to signpost or request a referral via their GP. 

1.      The client's policy does not cover the suggested number of sessions (Connected Care). Sometimes, we might approve a request clinically, but the client then says they do not have cover. In that case, the therapist must adhere to the limits of the client's cover, otherwise the client could be liable for extra costs.

1.      The reason for requesting to restore a late cancelled/DNA session is not considered a mitigating circumstance. "Mitigating circumstances" would usually cover issues such as emergencies, technical issues accessing a VHG system, urgent medical appointments or cancer/treatment related sickness for Macmillan patients, and other urgent issues outside clients’ control. However, this would not cover things like forgotten sessions, double bookings, lost devices, clashes with work shifts or overtime. 

1.      The client has already had a previous DNA or late cancel restored or has had 2+ DNAs/late cancels. In general, we would only consider restoring one session per therapy block and if a client has already had 2 DNA or late cancels for other reasons, attendance and suitability of continuing would need reviewing at this point.