We can work with all private insurance policies that offer coverage for our services. Whether your policy is in-network, out-of-network, or you are uninsured we will help you evaluate all payment options so you can determine which route will be the most affordable. As a medical services provider we can also accept credit or debit card payments from the tax-free contributions made to your Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) saving you even more. We believe in full transparency so anyone considering our services will always know exactly what to expect. This page explains how we bill patients and/or their insurance company when a health insurance policy is used.
Insurance Network Status
|CareFirst BlueCross BlueShield
|Johns Hopkins EHP
|United HealthCare (Optum)
* We can help our patients receive out-of-network reimbursement from the insurance company. In order to do this the insurance policy must have out of network coverage.
@ Due to extensive regulations imposed by Medicare, we are not able to accept any patients who are currently enrolled in Medicare at this time.
In-Network Insurance Billing
We handle in-network insurance billing so you do not have to worry about it. This page is simply provided for transparency for anyone interested in details of how we do so. Insurance companies require that we collect all applicable deductible, copay, and/or coinsurance amounts directly from patients. In order to simplify the billing process and maintain a high quality of care, we collect these amounts upfront on or near the appointment date.
When you schedule an initial evaluation with us, we will charge a $99 deposit to reserve the appointment time. As long as you attend the appointment this $99 deposit will be credited toward your appointment cost on your appointment date.
If your policy has no yearly deductible, the deductible does not need to be met for mental health care, or you have already met the deductible: After you attend the appointment we will refund the $99 deposit, minus any copay or coinsurance you are responsible for. We will then bill your insurance company for the remainder.
If your policy has an unmet yearly deductible: After you attend the appointment, we will apply the $99 toward your total appointment cost and process a second charge for the remaining amount of the evaluation. We will then file a claim with your insurance notifying them of your payment so you receive credit towards your deductible.
If you do not attend the appointment: The appointment deposit will be non-refundable to help (partially) mitigate the expenses involved in processing a new patient request and reserving the healthcare providers time. Insurance will not cover missed appointment fees.
If you have no yearly deductible or have already met the deductible: Up to 24 hours prior to the appointment time we will charge your payment method on file any applicable specialist copay or coinsurance requirements. We will then bill your insurance company for the remaining cost after the appointment.
If you have not met your yearly deductible: Up to 24 hours prior to your appointment time we will charge your payment method on file an estimate for the service provided. If this amount is inaccurate we will make a correction following your appointment. We will then file a claim with your insurance company so they apply this amount towards your deductible.
If you do not attend the appointment: A missed appointment fee will apply. If we have already billed in excess of the missed appointment fee we will refund the difference. If we have not billed the full cost of the missed appointment fee we will add the difference via an additional charge.
Out-Of-Network Insurance Billing
If you have an out-of-network policy with out-of-network coverage: We will bill you our standard rate for services provided and then help you submit a claim to your insurance company so they can reimburse you.
For new patient evaluations we charge a $99 deposit to hold the evaluation time. As long as one attends their appointment the $99 will be credited toward their evaluation cost. As the evaluation begins we will bill the remaining amount of the standard evaluation fee.
Within 30 days following the appointment date we will provide a copy of the receipt and all documentation necessary for the patient to submit a claim to their insurance company. We will handle the confusing and time consuming aspects of the documentation. The patient will simply need to fill out a claims form, attach the documents we have provided, and submit the claim online or through the mail. The insurance company will then send a check directly to the patient for the amount of the service the insurance company is responsible for.
We charge the payment method on file the standard rate for the anticipated billing codes up to 24 hours prior to the appointment date. If the estimate is inaccurate an adjustment will be made immediately following the conclusion of the appointment. Claims and reimbursement is then handled the same way as previously described for the initial evaluation.
Total Billed When Using Insurance
When billing insurance we charge a variable amount overall because we are required to bill from a set of insurance service codes and the code(s) used depend on a number of variables during each appointment. While we will not know the exact amount until the appointment is concluded our standard evaluation rate is usually $350. In fewer cases the cost may be $300. Follow-up appointments will usually be billed $150 for stable patients and $200 for those with substantial needs. Evaluations will never exceed $350 and follow-ups will never exceed $200 based on our current standard rates for service, which may change at any time with 30 days' notice. Patients may also opt to utilize our cash discount instead of using insurance if that will save them more.
The rate that we charge is the same for both in-network and out-of-network patients, but there is one major difference. Let's say someone has presented for an evaluation and their total bill is $350. The insurance company may only pay $275 for the service code(s) we bill. If the policy is in-network we will accept the reduced rate of $275 and will write-off the remainder; neither the patient or the insurance company will have to pay the $75 difference. If the policy is out-of-network we will not accept the $275 as full payment and the patient will be solely responsible for the $75 difference (in addition to any amount of the covered portion they are responsible for).