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.

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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 an invoice (aka "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.

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Typical visit fees - NEW notice below - PLEASE READ

(Fees are in keeping with those in the community and nationwide.)

 

March 1, 2024                                                   

 

With kind regards to the patients of Dr. Weibrecht,

 

We hope this letter finds you well. We are writing to inform you about some changes to our fee structure that will be implemented starting June 3, 2024.

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In order to continue providing you with the highest quality of care and maintain the standard of our services, as well as keeping with the standards in the community, we will be making a necessary adjustment to our fees. This decision has not been made lightly. We have kept our rates the same for the past two decades. However, it is now essential to cover the rising costs of overhead, including but not limited to supplies, equipment, and administrative expenses.

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Please be assured that our commitment to your health and well-being remains our top priority. We strive to provide you with the best possible care, and these changes will enable us to continue investing in the latest medical training, office environment, and more, to serve you better.

 

The new fee structure will be as follows:

• New patient evaluations – 1 hour, 20 minutes - $400

• 2nd new patient appointment, therapy, or extended appointments for new circumstances and evaluation – 45/50 minutes - $275

• Maintenance/follow up appointment – 20/25 minutes - $175

• Maintenance/follow up appointment for stable longstanding patients – 15 minutes - $125

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Autism Spectrum Disorder (ASD) Evaluations – children and adults

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These comprehensive evaluations involve 4 appointments and include the following appointments and report(s):

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• New Patient Initial Evaluation or Update to Evaluation – 1 hour, 20 minutes and 50 minutes, respectively – $400 and $350, respectively

• Evaluation for other symptoms or disorders, if any (which may overlap with, or be confused for, ASD) – 50 minutes– $250

• Autism Diagnostic Observation Schedule-2 (considered the gold standard for aiding in diagnosis of ASD, and required by most agencies) – $300

• Review of Overall Findings and Evaluation for ASD specific criteria – 50 minutes – $250

• Reports (one main report for submission to agencies/schools, if indicated, as well as other reports, if indicated ) – $275

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We understand that this may be an unexpected change and we are more than willing to discuss any concerns you may have about this adjustment. If you have questions or need more information, please do not hesitate to contact our office at 520-428-3933.

We greatly appreciate your understanding and continued trust in us for your healthcare needs. We look forward to continuing to serve you and your family. Thank you for your understanding and cooperation in this matter.

Sincerely,

Dr. Weibrecht

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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. 

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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.