Insurance Coverage
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 can 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
| Insurance Policy | In-Network | Out-Of-Network* | FSA-HSA Eligible |
|---|---|---|---|
| Aetna | |||
| CareFirst BlueCross BlueShield | |||
| Cigna | |||
| Johns Hopkins EHP | |||
| Kaiser Permanente | |||
| United HealthCare (Optum) | |||
| Medicaid | |||
| Medicare | N/A | N/A | N/A |
* 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.
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 automatically up to 72 hours prior to the appointment start time.
Initial Evaluation
When you schedule an initial evaluation with us, we will charge a $150 deposit to reserve the appointment time. As long as you attend the appointment this $150 deposit will be credited toward the total cost on your appointment date.
If your policy has no yearly deductible, the deductible does not need to be met for our service type, or you have already met the deductible: After you attend the appointment we will refund the $150 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 $150 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. The total evaluation cost is billed at $350, but we will accept the amount contracted with the in-network insurance company if it less than $350.
If you do not attend the appointment: The $150 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.
Return Visits
If you have no yearly deductible or have already met the deductible: Up to 72 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 72 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: Insurance will not cover missed appointment costs so the cash discount rate of $125 will apply for all missed appointments. If the original insurance estimate was less than $125, a second charge will be processed to total the $125 cost. If a makeup appointment is booked quickly after the missed appointment, a courtesy refund of up to a maximum $100 of the original $125 may be issued for the original missed appointment cost. These refunds are calculated and applied automatically in a sliding scale fashion only to those individuals with a long-term track record of routine appointment attendance.
Out-Of-Network Insurance Billing
Baltimore Psychiatry offers courtesy billing for out-of-network services. If you have an out-of-network policy with out-of-network coverage: We will bill you our standard rate for services and then file a claim with your insurance company on your behalf so they directly reimburse you. If it looks like you would save more by using our self-pay discount instead of billing through insurance, we will do our best to make sure you are aware (if requested). We usually file claims within 30 days of the date of service but may take up to 60 days to do so in some cases.
Initial Evaluation
For new patient evaluations we charge the standard rate of $350 for the evaluation service at the time of booking. If you have an out-of-network policy we will handle all the paperwork and file a claim with your insurance company. The insurance company will then send payment directly to you for the amount of the service the insurance company is responsible for. Please note evaluation appointments are not eligible for cancellation or refunds if missed and insurance companies will not cover missed appointment fees.
Return Visits
For return visits we charge the payment method on file $150 up to 72 hours prior to the appointment date*. Claims and reimbursement is then handled the same way as previously described for the initial evaluation.
* This is where things get complicated with insurance. When billing insurance we are legally required to bill for the exact service codes provided. On occasion, the follow-up appointment cost may end up reaching $200 instead of $150 (this can happen when patient acuity is higher or additional time is spent providing same-day patient care directly or indirectly). In these instances a $50 payment will be added to the original $150 payment to total $200 before processing the claim. In the extremely rare case that someone has even more extensive needs that would result in even higher service code billing, we would ask them to schedule an additional appointment.
In summary, the majority of follow-up appointments are $150 but sometimes they may reach $200. They will not exceed $200 based on our current standard rates for service (which may change at any time with 30 days' notice).
How can I verify that my policy has out-of-network benefits?
Not all private health insurance policies have out-of-network (OON) benefits. The only definitive way to determine if your policy has OON coverage is to call the insurance company customer service line or review the documentation accompanying the policy. You can also review your insurance plan type, which is often written on your health insurance ID card:
- Preferred Provider Organizations (PPO) plans should have OON benefits.
- Health Maintenance Organizations (HMO) and Exclusive Provider Organizations (EPO) plans do not provide out-of-network coverage.
Your health insurance ID card might have an "out-of-network" or "OON" deductible field on it. This should indicate coverage if there's a dollar amount shown (including $0). However, if "N/A" is shown in this field it means "not applicable" and indicates you do not have OON coverage. Keep in mind that a policy may still have OON coverage even if this field is not displayed on the card.