I work in multiple settings that do accept insurance and, in some cases, offer care free-of-charge if an individual is uninsured. However, in my private practice, I do not participate in insurance plans. In this setting I will help individuals obtain out of network reimbursements from their insurer when applicable.

Fees for consultations/evaluations and follow-up sessions are due the day of service. I accept payment via check, cash, credit card or Zelle.

Questions to ask your insurance provider when seeking out-of-network reimbursement:

1. Do I have out-of-network benefits for mental health services?

The best way to find out if you have out-of-network reimbursement is to call your insurer directly and ask if you are eligible. You can also ask about the process by which you can submit claims for reimbursement. Most plans that offer out-of-network coverage will reimburse a percentage of their “reasonable and customary” (R&C) fee, after an out-of-pocket deductible is met.

2. Do I have a deductible?

This is the amount your insurance provider expects you to pay before they will start reimbursing. Most plans have a yearly deductible.

3. What is the reasonable and customary fee for an initial evaluation (e.g codes 99204 or 99024) or a follow-up appointment (e.g 99213 plus 90836 or 99214 plus 90833) in zip code 10024? Is my psychiatrist’s rate at or below this fee?

Of note: As a physician, I typically will use a billing code with a psychotherapy as on. For example for a 30 minute follow-up appointment, the codes submitted with be both 99213 plus 90833.

4. Does my plan have a maximum out-of-network annual limit?

Example:

If your insurance covers 80% of out-of-network costs after you reach your deductible (e.g $1,000) and the fee for service is $300, they will reimburse you $240. You would then be responsible for $60 per session.

Fee Policy and Obtaining Reimbursement