Insurances and Mental Healthcare and Integrative Medicine care
As of May 1, 2015 our clinic has decided to opt out of insurance networks and is considered a non-participating and out-of-network provider.
Depending on your insurance, you may be able to get reimbursed for visits or a percentage of what you pay us from your insurance carrier. You will need to submit paper work to your insurance company. For your convenience, we will provide you with the receipt and try to assist with filling health insurance claim forms that you will need to submit for reimbursement.
Please note that the money you spend for out-of-network psychiatric and integrative medicine services may count towards your insurance deductible.
Historically, most integrative medicine modalities are considered as a non-covered benefit. This poor reimbursement limits the options available to patients. Additionally, mental health reimbursement is also limited by insurance policies. It is for this reason that over half of U.S. Psychiatrists do not accept insurance.
Current mental health and insurance models promote short “medication review” and pharmaceutical driven model of psychiatric care. We believe the current care models interfere with our ability to provide optimum care.
It was only after struggling with the current insurances that we came to the decision of opting out of insurance networks. We will continue to strive for personalized, caring, empathic, holistic and wellness based care and not let care be guided by insurance reimbursement models.
Kindly note that as copay amounts and deductible limits have sharply risen over the last few years even “in-network” or “covered” benefits are actually patient responsibility and reimbursed by patients. (Thus directly billing patients just eliminates bureaucratic insurance billing process and does not significantly impact patients’ bottom line.)
We understand and empathize that dealing with insurance increases the patient’s responsibilities and effort burden. However, we feel that patient’s involvement will hopefully increase awareness and activism towards reforming the current healthcare models towards improved and patient driven care. For our part, we will continue to strive to minimize patient’s cost and welcome patients to compare rates and services with other local and national norms.
Here are some responses to Frequently Asked Questions (FAQ) about billing:
1. Will I need to see a therapist or Nurse Practitioner first?
A. NO. All Patients are seen by Psychiatrists.
At some clinics you may see a Therapist, Nurse Practitioner, or Physician’s Assistant instead of a psychiatrist. A psychiatrist is able to prescribe medication if needed and has four years of medical school and four years of residency. Thus there is a significant difference in knowledge base. Some clinics may require you to see a therapist as well as the psychiatrist and that can mean double visits and thus double charges.
2. Aren't the office visits more expensive than at a clinic that accepts my insurance?
A. NO, not necessarily. It depends on multiple factors including deductibles.
Deductible is the amount you pay before insurance starts covering for visits. These days deductible amounts can be above $5000 at times. If you have a high deductible, it may be advantageous to come to our office as sometimes our charges may be lower for some codes than insurance allows. It is best to find out what your deductible amount is? For example if you have a deductible of Thousand Dollars, wherever you go you will be responsible to pay up to that amount.
Our charges are very simple and based on the time spent with you. You do not have to deal with complicated coding to understand how much your visits will be and can make better informed decisions. In fact, our charges are in the range that most insurances reimburse for services and often times are lower depending on codes submitted. We encourage you to compare our prices with those of other clinics. Our initial appointment may seem higher but keep in mind it is a longer one and half hour appointment with Psychiatrist.
3. Even though I pay upfront for the appointment, can I still submit my claim to the insurance?
A. Yes.
We give you a detailed receipt with Diagnoses codes, Data of service, Procedure codes which you can use to submit to your insurance for reimbursement or to be applied to your deductible.
However, if you have Medicare you may not submit for the reimbursement as our clinic has chosen to opt out of Medicare. See Medicare form which is part of initial office forms under Appointments tab.
4. Are you considered In-network or Out-of-network?
A. We are considered Out-of-network. However at times, insurances have made an exception if they have a restricted network. There may be a difference between in network and Out-of-network coverage e.g. some plans may cover 80% of visit if in network vs 60% if out of network. We recommend that you call your insurance provider for more information on its specific policy for out of network practices.
Most people believe that if they go to In-network provider all services are covered. That is not true, you are still responsible for deductible, copay and may need prior authorization e.g. average copay can be $45 for specialists. Thus for medication reviews, you will be paying $45 out of $80 and insurance covers only $35 after you meet your deductible.
5. Any suggestions?
A. We advise you to call your insurance and find out about mental health coverage including:
a. Deductible
b. Copay
c. Out-of-network coverage
You may then call our office with any questions or clarifications. We can guide you so that you can make an informed decision. Our office staff can assist you in filling out forms if required to submit to insurance.
As of May 1, 2015 our clinic has decided to opt out of insurance networks and is considered a non-participating and out-of-network provider.
Depending on your insurance, you may be able to get reimbursed for visits or a percentage of what you pay us from your insurance carrier. You will need to submit paper work to your insurance company. For your convenience, we will provide you with the receipt and try to assist with filling health insurance claim forms that you will need to submit for reimbursement.
Please note that the money you spend for out-of-network psychiatric and integrative medicine services may count towards your insurance deductible.
Historically, most integrative medicine modalities are considered as a non-covered benefit. This poor reimbursement limits the options available to patients. Additionally, mental health reimbursement is also limited by insurance policies. It is for this reason that over half of U.S. Psychiatrists do not accept insurance.
Current mental health and insurance models promote short “medication review” and pharmaceutical driven model of psychiatric care. We believe the current care models interfere with our ability to provide optimum care.
It was only after struggling with the current insurances that we came to the decision of opting out of insurance networks. We will continue to strive for personalized, caring, empathic, holistic and wellness based care and not let care be guided by insurance reimbursement models.
Kindly note that as copay amounts and deductible limits have sharply risen over the last few years even “in-network” or “covered” benefits are actually patient responsibility and reimbursed by patients. (Thus directly billing patients just eliminates bureaucratic insurance billing process and does not significantly impact patients’ bottom line.)
We understand and empathize that dealing with insurance increases the patient’s responsibilities and effort burden. However, we feel that patient’s involvement will hopefully increase awareness and activism towards reforming the current healthcare models towards improved and patient driven care. For our part, we will continue to strive to minimize patient’s cost and welcome patients to compare rates and services with other local and national norms.
Here are some responses to Frequently Asked Questions (FAQ) about billing:
1. Will I need to see a therapist or Nurse Practitioner first?
A. NO. All Patients are seen by Psychiatrists.
At some clinics you may see a Therapist, Nurse Practitioner, or Physician’s Assistant instead of a psychiatrist. A psychiatrist is able to prescribe medication if needed and has four years of medical school and four years of residency. Thus there is a significant difference in knowledge base. Some clinics may require you to see a therapist as well as the psychiatrist and that can mean double visits and thus double charges.
2. Aren't the office visits more expensive than at a clinic that accepts my insurance?
A. NO, not necessarily. It depends on multiple factors including deductibles.
Deductible is the amount you pay before insurance starts covering for visits. These days deductible amounts can be above $5000 at times. If you have a high deductible, it may be advantageous to come to our office as sometimes our charges may be lower for some codes than insurance allows. It is best to find out what your deductible amount is? For example if you have a deductible of Thousand Dollars, wherever you go you will be responsible to pay up to that amount.
Our charges are very simple and based on the time spent with you. You do not have to deal with complicated coding to understand how much your visits will be and can make better informed decisions. In fact, our charges are in the range that most insurances reimburse for services and often times are lower depending on codes submitted. We encourage you to compare our prices with those of other clinics. Our initial appointment may seem higher but keep in mind it is a longer one and half hour appointment with Psychiatrist.
3. Even though I pay upfront for the appointment, can I still submit my claim to the insurance?
A. Yes.
We give you a detailed receipt with Diagnoses codes, Data of service, Procedure codes which you can use to submit to your insurance for reimbursement or to be applied to your deductible.
However, if you have Medicare you may not submit for the reimbursement as our clinic has chosen to opt out of Medicare. See Medicare form which is part of initial office forms under Appointments tab.
4. Are you considered In-network or Out-of-network?
A. We are considered Out-of-network. However at times, insurances have made an exception if they have a restricted network. There may be a difference between in network and Out-of-network coverage e.g. some plans may cover 80% of visit if in network vs 60% if out of network. We recommend that you call your insurance provider for more information on its specific policy for out of network practices.
Most people believe that if they go to In-network provider all services are covered. That is not true, you are still responsible for deductible, copay and may need prior authorization e.g. average copay can be $45 for specialists. Thus for medication reviews, you will be paying $45 out of $80 and insurance covers only $35 after you meet your deductible.
5. Any suggestions?
A. We advise you to call your insurance and find out about mental health coverage including:
a. Deductible
b. Copay
c. Out-of-network coverage
You may then call our office with any questions or clarifications. We can guide you so that you can make an informed decision. Our office staff can assist you in filling out forms if required to submit to insurance.
