A few words about insurance and why I do not participate with insurance companies:
I hold myself to very high standards of patient care. Many physicians today are put under pressure to see more and more patients for less and less reimbursement. In psychiatry, patients are often limited in the number and types of visits they are 'allowed' by their insurance companies. More and more physicians are finding it difficult to provide high quality health care in the face of rising costs, declining reimbursements, and enforced time limitations. Many psychiatrists are forced to see patients only for medication management; an initial consultation may be 45 minutes or less and follow-up appointments only 10 minutes long. I cannot fathom how one can establish a trusting relationship with a patient or even begin to understand the complex individual who that person is in such a small amount of time.
I offer 3 services: an initial consultation which is 3 to 4 hours long, a one hour psychotherapy session (with or without medication management), and a one half-hour medication management session. In special circumstances with elderly and frail patients who cannot come to my office I offer home visits. Financial compensation for psychiatrists who see a different patient every 10 minutes far exceeds that of my fees, but I refuse to sacrifice quality patient care at any cost.
Insurance companies are for profit; their primary loyalty is to their shareholders and millionaire CEOs, not the insured. They refuse to pay equally and have tight restrictions for access to mental health treatment compared to other medical care. In addition, in order to 'qualify' for treatment patients must first ask permission to see a psychiatrist and afterward, if the insurance companies are to pay for any of the treatment, they must receive a treatment plan from the psychiatrist that reveals confidential patient information, and I have very strong reservations about this.
Should you wish to seek reimbursement through your insurance company I will be glad to assist you with this and include you in each step of the process, often times filling out forms and writing letters together so that you can determine exactly what information is given to them. Before out first session I highly recommend that you contact your insurance company to inquire about reimbursement with an 'out-of-network' provider. You will need the codes for the various services called 'CPT codes'. Although my services are limited to those described above, the reimbursement varies depending upon which code is used. For the initial consultation, I use 90801 or 99245 + 99354 (extended service). For hour-long sessions I use 90807 or 99215. For medication management sessions I use 90805, 99215, or 90862, For home visits I use 99345-21 (for the consultation) and 99350-21 for follow-up visits. When calling your insurance company to ask about reimbursement they will usually quote you a percentage of the "usual and customary fee" (which is an arbitrary amount established by the insurance companies that in no way reflects the actual fees of physicians). Your out-of-pocket expense can be calculated by subtracting the percentage of the quoted usual and customary fee from the actual fee. Also, when calling the insurance company be sure and ask them if "pre-authorization" is required, otherwise they can refuse to pay any of your bill because you didn't ask them permission first.
Medicare Patients
I have "opted-out" of Medicare; this means that if you have Medicare as your primary insurance, you will not be able to submit bills to Medicare for reimbursement. If you have secondary insurance, you may submit bills to them, however, reimbursement depends entirely upon the 'out-of-network' benefits that your individual policy has. I strongly recommend contacting your insurance company prior to an appointment to find out how much you will be reimbursed.
Should you have any questions regarding this policy, please do not hesitate to contact me.
