APPOINTMENTS
APPOINTMENTS
I am an out-of-network provider for insurance companies. Payment is expected in full at the time of your office visit. I accept payment by cash, check, credit or debit cards, and FSA/HSA/HRA cards. At the end of each month, I can provide you with a statement called a “superbill” which contains all of the information your insurance company will need which you can then submit to them for reimbursement. Please check with your individual insurance company to find out the details of what they will reimburse you. One advantage is that this allows me to spend more time with my patients and less time on paperwork/forms. It maximizes your privacy and also puts you in control of what information you make available to your insurance company. Treatment decisions are made together with your physician, rather than dictated by insurance companies or managed care organizations.
When calling your insurance for benefit and coverage questions, it is imperative that you tell them it is for psychiatric/mental health services, as most insurance companies handle these claims differently. Some even go through an additional, separate insurance carrier altogether; Usually those companies list the mental health benefit number on the back of your insurance card separately. I always recommend actually speaking with a customer service representative with your carrier, to get the most current, accurate information available. Medicare is not eligible for reimbursement. Medicaid most likely is not covered and may require prior authorization – please call them for more details.
Questions to Ask Your Insurance Provider:
Do I have Mental Health benefits?
What are my Out of Network benefits?
Is there a deductible before I am reimbursed?
Can I submit my own claims?
What is your reimbursement rate?
Do I have a maximum amount of money or visits that are allowed?
You can file a complaint with your insurance company to have your visits considered “in network” based upon limited availability of psychiatrists in the area that are in network. To do this, please go to:
CONSULTATIONS
– Consultations are billed at my hourly rate of $450 and are prorated to reflect only the amount of time that was spent. A credit card is required on file to hold your appointment. No shows are charged at the hourly rate for the amount of time that was held for the appointment (ie, 60 minutes for follow ups and 120 minutes for initial consultations). Cancellations within 24 hours of the appt are charged $225 if made the day prior to the appointment and $450 the day of the appointment. If we have agreed upon an extended follow up visit (90 minutes), the cancellation fee is $337.50 if cancelled within 24 hours if made the day prior and $675 on the day of the appointment. Payment is expected in full on the day of the appointment. If the credit card on file is declined, you will be contacted and given 24 hours to make payment; If payment is not made, a declined payment fee of $100 will be incurred.
– Adult: There is one appointment lasting approximately 2.5-3 hours. This appointments will be coded 99205.
– Children: There is usually one appointment. I would like to speak to your child alone at some point during this visit. If your child would be distressed speaking to me without you present, that is no problem, we will do the entire appointment with all of you together. This appointments will be coded 99205. It is usually about 2.5-3 hours in duration.
– Adolescents (12 years olds to 18 year olds still attending high school): We can do this in one of two ways: 1) Two consultation appointments: One with the parent(s)/guardian(s) alone and another with the adolescent for the majority of the time and with the parent(s)/guardian(s) joining after this to discuss my feedback and develop a plan. Each of those appointments would be approximately 90 minutes long, OR 2) One long appointment where both the parent(s)/guardian(s) and the teen would have separate time to speak with me and then we would convene at the end as a group to discuss my feedback and develop a plan which would be approximately 3 hours long. Of note, durations given for appointment times are only estimates as actual time spent will vary upon complexity of patient needs and how much information they/you are wanting to share. The initial appointment will be coded 99205.
Every attempt will be made to match treatment to your specific needs. During the consultation visit(s), information is gathered to identify problems and discuss treatment goals. After the assessment is complete, a decision will be made about whether I can best meet your needs or if an outside referral would be more appropriate. Scheduling a consultation does not guarantee that a treatment relationship will be established.
Once the consultation appointment(s) has/have been completed and all parties agree that this is a good fit, we can schedule a follow up appointment. Follow up appointments usually take between 45 to 60 minutes, but 60 minutes are always held in case they are needed. Frequency depends on how someone is doing and is determined on an individual basis. To continue to prescribe medication, I need to see the person at least once every three months. Codes for these could be 99213, 99214, 99215 and possibly 90833, 90836, or 90838 depending on complexity and content of the appointment.