If we are out of network for you, as a courtesy to you, we will file your insurance claim for you if we have received all your insurance information on the day of the appointment, you have paid for the session in full, and you have a PPO. Please be familiar with your insurance benefits, as we will collect from you the fee and the insurance company will send you the reimbursement. We file insurance claim electronically so your insurance company will receive the claim within days of the treatment.
We are not responsible for how your insurance company handles its claims or for what benefits they pay. We can only assist you in sending in your claim per appointment, we at no time guarantee what your insurance will or will not do with each claim. We also cannot be responsible for any errors in filing your insurance, once again we file claims as a courtesy to you. No insurance pays 100 percent of the costs of all procedures. Medicare and Medicaid do not have a PPO therefore this procedure does not apply. It also will not apply to HMO plans.
Mental Health insurance is meant to help with the costs of mental health care. Many patients think that their insurance pays 90 to 100 percent of fees. In reality, most pay between 50 to 80 percent of the average fee, depending on which plan you or your employer chose and what procedure is needed. We advise all of our patients to become more familiar with your plan, what is covered and what percentage is covered. Benefits are determined by our office as well.
Often your insurer reimburses you or the therapist at a lower rate than the therapist's actual fee and deems the rest to have exceeded the usual, customary, or reasonable fee ("UCR") used by the company. This label gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or higher than other therapists in the area. This can be very misleading and is simply not accurate.
Insurance companies set their own policies. "Allowable" fees vary widely and can be based on arbitrary or outdated data.
Unfortunately, insurance companies imply that the therapist is "overcharging" rather than say that they are "underpaying" or that their benefits are low. In general, insurance policies vary, and so does it's usual, customary, or reasonable (UCR) figure.
Most importantly, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment. Please know that we will do everything possible to see that you receive the full benefits of your policy. Missed appointments or unexcused cancellations are billed at the hourly rate but are not reimbursable by any insurance company.
Contact Us for more information.