Considering insurance versus self-pay options

 

Dr Weibrecht strongly believes that her patients' health and well-being come first. Due to increasingly complicated demands of insurance companies and other circumstances that have affected psychiatrists' ability to spend time with patients, Dr Weibrecht, like many other psychiatrists nationwide, has converted to a practice for self-pay patients. There are many benefits to this type of practice.

 

First and foremost, Dr Weibrecht will be able to spend more time with you and your child rather than the inordinate amount of time required to contend with insurance billing issues, prior authorizations for medications, etc.

 

Furthermore, length and type of treatment is not dictated by the insurance company. While some managed care programs interfere very little with the consumer’s choice of type or length of treatment, others make many of the important decisions for the patient. Examples include, but are not limited to, the length of treatment, the type of therapy, the use of medication, the medication brand or type, and referral to self-help groups instead of professional services.

 

One other consideration is that medical expenses are, in part, tax deductible. 

 

If you would like to be reimbursed by your insurance company, Dr Weibrecht's office will provide you with a "superbill". This specifies the service(s) provided and the fees paid. Some insurance companies may not reimburse, for example, if you have a deductible, however, some will reimburse anywhere from 40 to 80%. If you are considering this option, you may want to check with your insurance company prior to the initial evaluation.

 

 

Typical visit fees

(Fees are in keeping with those in the community and nationwide. Please note that changes in 2013 to medical billing codes require that certain services are billed depending on patient status and severity of symptoms, as well as therapeutic issues discussed and other criteria.)

 

Initial Evaluation (Including and not limited to: Review of presenting difficulty, family and personal history, order and medical interpretation of laboratory or other diagnostic studies, initial recommendations:)  Insurance reimbursement depends on presenting issues, complexity, etc, and you will receive a statement inline with current medical coding requirements.   The rate will remain a flat rate of $350 for this time frame, nonetheless.

 

​Follow up (therapeutic services/medication management - 20-25min:  Insurance reimbursement depends on presenting issues, complexity, etc, and you will receive a statement inline with current medical coding requirements. The rate will remain a flat rate of $150 for this time frame, nonetheless.

 

​Follow up (therapeutic services/medication management - 45-50 min:   Insurance reimbursement depends on presenting issues, complexity, etc, and you will receive a statement inline with current medical coding requirements.. The rate will remain a flat rate of $220 for this time frame, nonetheless.

 

 

Important - Please note:

 

1) The initial session is a diagnostic evaluation and not a therapy session. If your child/teen has a pause in follow up sessions of more than six months, a repeat initial evaluation session charge will be necessary for a comprehensive review for changes in his/her condition and health.

 

2) Cancellations with less than 48 hours notice for a 20-30 minute time slot will incur a $50 fee. Less than 24 hour notice will incur fee of $75. 

Cancellations with less than 48 hours notice for a 45-50 minute time slot will incur a $70 fee. Less than 24 hour notice will incur fee of $90.

 

3) Phone consultations lasting more than 5 minutes will incur a fee based on time and complexity.

 

4) Additional charges may apply for written documents. 

 

 

Reimbursement

To Find Out How Much Your Health Insurance Company Will Reimburse:

 

1. Consult your health insurance brochure, and/or,

 

2. Call your health insurance company, either before or after your first visit, and have the following conversation:

          a) Tell the person with whom you are speaking that you are seeing an “out-of-network” psychiatrist.

          b) Ask how much you will be reimbursed for CPT (Current Procedural Terminology) Code 90792 (initial consultation) and follow up codes such as 99213 or 99214, as well as 90833 or 90836.

          c) Ask how much your annual deductible is.

         d) Ask how many certified visits you have per calendar year.

 

3. Submit an invoice, see how much reimbursement you receive, and read the enclosed E.O.B (Explanation of Benefits). Most health insurance companies are required by law either to pay the claim, or tell you why they are not going to pay. Within 30 days, you can call your health insurance company and ask about the “status” of your claim.

 

4. You should then have all the information you need to know how much insurance reimbursement you can expect to receive for your treatment. 

© Catalina Foothills Pediatric Psychiatry