I currently accept Anthem Blue Cross and Cigna insurance. However you may be eligible for out-of-network reimbursement. If you would like to use this benefit, you may wish to call your insurance company and ask them the following questions.
How much does my plan cover for an out of network provider?
What is my out-of-network annual out-of-pocket cap?
Do I have to have a “parity” (i.e., severe) diagnosis, to qualify for benefits?
How many sessions per calendar year does my plan cover for a parity, or non-parity, diagnosis?
What is the maximum coverage amount (sometimes called the “UCR”, or “usual and customary rate”) for procedure codes?
Is approval or a referral required from my primary care physician?
Do I need to obtain pre-authorization?
Are my benefits on a calendar year basis, or a plan year? If on a plan year, when does it start?
Will my insurance pay for the treatment?
Most insurance companies do provide some mental health coverage. Please contact your health insurance to find out more about your mental health benefits.
Are there any advantages to being seen out of network?
Yes, when your visit is not billed through insurance you get the following benefits:
Quality: You/your child are free to get the best clinical care possible, without any interference from the insurance company.
Access: Appointments can last as long as they need to and can be as frequent as necessary.
Privacy: if you do not seek reimbursement from your insurance company, your/your children’s chart is completely confidential and will never be released to an insurance company without your permission.
Financial: Many who do choose to seek reimbursement are surprised to find that the process is relatively simple and the benefits higher than assumed.
How do I get reimbursed by my insurance company on an out-of-network basis?
Once you have paid your balance in full, you simply submit your receipt (which shows all necessary diagnostic and procedural codes and that you have paid) along with your insurance company’s claim form (typically found on their website), either by fax or mail, and your insurance company mails you a check. Insurance companies will not accept claims for dates that have not been paid.
The amount they send you, once you meet your out of network deductible and assuming you have obtained any necessary prior authorizations, is based on the percentage or out-of-network coverage your plan authorized (typically 50-80%) of the allowable rate, which varies based on plan. Please note insurance plans typically do not cover time spent in your/your child’s care in between sessions.
My office will be happy to help you estimate what your actual total cost will be once you call your insurance company and get the information above, and to give you any guidance I can in the process.
Do you accept Health Saving Account, Flexible Saving Account, or Health reimbursement Account (HAS/FSA/HRA) debit cards?
Yes. If you have a pre-tax account set aside for healthcare expenses, you may use the debit card that is associated with that account, or, you many pay by check and submit your receipt to that account for reimbursement. If you do not have one, ask your human resources department if you can set one up.
3. Medical Questions
What is a mental illness?
A mental illness is a medical condition that can disrupt a person’s thinking, feeling, mood, ability to relate to others and ability to function. Just as diabetes is a disorder of the pancreas, mental illnesses are medical illnesses that often affect the brain.
What are the causes of mental illness?
The exact cause of mental illness is not known but researchers have shown that these conditions are caused by a combination of biological, psychological and environmental factors.
Who gets mental illnesses?
Anyone can have a mental illness. Mental illnesses can affect persons of any age, race, religion or income.
How common are mental illnesses?
Mental illnesses are very common: in fact, they are more common than cancer, diabetes or heart disease. According to the U.S. Surgeon General, an estimated 23% of American adults (those ages 19 and older) or about 44 million people, and about 20% of American children suffer from a mental health disorders during a given year.
What are the warning signs of mental illness?
The warning signs differ depending on the type and intensity of the illness. Some common signs are sleep and appetite disturbance, lack of energy and motivation, confusion, decreased work performance, thoughts of suicide, intense fear or anxiety, difficulty in attention and concentration, unexplained physical symptoms, using drugs and/or alcohol, irritability, social withdrawal and decreased ability to function.
What treatment options are available?
Just as there are different types of treatment for other medical illnesses, there are different treatment options for people with mental illness. Talk with your treatment team to tailor a plan that works best for you.
What are the chances of getting completely cured?
This depends on the severity and type of illness and should be discussed with your physician. Most people with mental illnesses who are diagnosed and treated will respond well and live full productive lives.
How do I get immediate mental health help?
Call 911 for emergency assistance if the situation is life threating or may result in immediate physical harm to yourself or another person or you are unable to care for yourself. You may also call the National Suicide Prevention Lifeline at 1-800-273-8255.
Questions? Get In Touch
If you have questions about my services or would like to schedule an appointment, call my office or fill out the form below.
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The contents of this site are for informational purposes only. The content is not intended as professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition, including mental health disorders. If you think you have a medical emergency, call 911 immediately.