Payment and Insurance:
You are responsible for paying all copays and fees at the time of service. Payment may be made by check, cash, or VISA, MasterCard, or American Express credit cards. Any checks returned are subject to an additional fee of $25.00 to cover the bank fees and other costs incurred. If you refuse to pay your debt, we reserve the right to use an attorney or collection agency to secure payment, and to charge you for our attorneys’ fees and costs.
In addition to weekly appointments, it is our practice to charge for other professional services that you may require such as testing, report writing, telephone conversations that last longer than 15 minutes, attendance at meetings or consultations which you have requested, or the time required to perform any other service which you may request of your therapist or from SDPC. If you anticipate becoming involved in a court proceeding, we recommend that you and your therapist discuss this fully before you waive your right of confidentiality. If your case requires Dr. Boscán or Dr. Rodenberger’s participation, you will be expected to pay for the professional time required even if another party compels either of them to testify.
Health Insurance Coverage:
In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. With your permission, our billing service and your therapist will assist you to the extent possible in filling claims and ascertaining information about your coverage, but you are responsible for knowing your coverage and for letting us know if/when your coverage changes.
Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. Managed Health Care plans such as HMOs and PPOs often require advance authorization, without which the plan may refuse to provide reimbursement for mental health services. These plans are often limited to short-term treatment approached designed to work out specific problems that interfere with a person's usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While some progress can be found in short-term therapy, your therapist might recommend longer-term therapy or you may come to realize the benefits of longer-term therapy. Some managed-care plans will not provide coverage for services once your benefits end. If this is the case, your therapist will do his/her best to find another provider who may be able to help you continue your treatment or you may wish to discuss other payment arrangements.
You should also be aware that most insurance companies require you to authorize your therapist to provide them with a clinical diagnosis. (Diagnoses are technical terms that describe the nature of your problems and whether they are short-term or long-term problems. All diagnoses come from a book entitled the DSM-IV-TR. We have a copy in our office and we will be happy to let you see it to learn more about your diagnosis, if applicable). Sometimes we have to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and probably will be stored in a computer. Though all insurance companies claim to keep such information confidential, we have no control over how that matter is managed. In some cases, your insurance company may share the information with a national medical information databank. We will provide you with a copy of any report we submit, if you request it. We also will provide you with an agreement that will enable to provide requested information to your carrier if you plan to pay with insurance.
In addition, if you plan to use your insurance, authorization from the insurance company may be required before the company will cover therapy fees. If you did not obtain authorization and it is required, you may be responsible for full payment of the fee. Many policies leave a percentage of the fee (which is called co-insurance) or a flat dollar amount (referred to as a co-payment) to be covered by the patient. Either amount is to be paid at the time of the visit by check or cash. In addition, some insurance companies also have a deductible, which is an out-of-pocket amount that must be paid by the patient before the company is willing to begin paying any amount for services. Typically this will mean that you will be responsible to pay for initial sessions until your deductible has been met; the deductible amount may also need to be met at the start of each calendar year. Once we have all of the information about your insurance coverage, we will discuss what we can reasonably expect to accomplish with the benefits that are available and what will happen if coverage ends before you feel ready to end your sessions. It is important to remember that you always have the right to pay for services yourself or out-of-pocket to avoid the problems described above, unless prohibited by your provider's contract.
If our therapists are not a participating provider for your insurance plan, we will supply you with a receipt of payment for services, which you can submit to your insurance company for reimbursement. Please note that not all insurance companies reimburse for out-of-network providers. If you prefer to use a participating provider, we will provide referrals to other community providers.
Insurance Related Advisement:
If you are using managed care benefits for your mental health services, you should know the following important principles:
Managed care benefits cover only “medically necessary” services. This is generally defined as evaluation and treatment of mental conditions that significantly affect your ability to perform your usual activities at home, work and/or school. Treatment is expected to be action-oriented and symptom resolving with goals for efficiency, effectiveness, and returning you back to your usual level of functioning at work, home or school.
Usually, insight-oriented psychotherapy treatment for long-term personal or relationship issues is not covered.
Pre-authorization of insurance coverage benefits is required. We do this by reporting clinical assessments and treatment plans to a treatment manager with your insurance company either by phone or in writing.
Sometimes patients wish to continue treatment, such as psychotherapy, beyond the insurance-covered portion. In this case, it is often possible to pay out-of-pocket for continued treatment with the same therapist.
Payment & Patient Responsibility:
You are responsible for payment in accordance with the rate and terms communicated and agreed upon between you and your therapist, our office will cause your insurance claim to be submitted to your carrier at no cost to you. However, this is not a guarantee of payment by your insurance company since the claim is based upon agreements between you and the insurer. If payment is not received within 90 days from the submission date the claim was submitted, you will be responsible for the full amount of the balance due on your account.
When clinical services are not covered by your health insurance plan, you are fully responsible for full payment at the time of service.
Typical examples include:
• Ongoing psychotherapy, if your insurance covers only short term evaluations, crisis-intervention, or "medically necessary" services.
• Psycho-educational groups.
• When your insurance company denies coverage.
• No-show for scheduled appointment or cancelling in under 48-hours.
In these circumstances, you are responsible for paying a fee depending on what, if any, is allowed by your specific health insurance plan.