Health Insurance
We accept and are in-network with the following private health insurance policies:
Optum (subsidiary of United HealthCare)
Cigna (also known as EverNorth)
We are not in-network with Medicaid or Medicare, regardless of the insurance company that is administering the benefits on their behalf. If your insurance is not listed or you do not have insurance, we have abnormally low cash pricing with fixed rates and a financial assistance program which can lower rates even further.
How Our Insurance Billing Works
We charge a deposit to book an evaluation time. We also collect all applicable deductible, copay, or coinsurance amounts on or near the appointment date. This page explains how that process works. Our new patient intake packet also provides a very detailed explanation and agreement form.
Evaluation Deposit
When you schedule an initial evaluation with us and have an in-network insurance policy, we will charge a $125 deposit to hold the time. As long as you attend the appointment this $125 deposit will be credited toward your appointment cost on your appointment date.
How We Charge Patients and Bill Their Insurance for an Evaluation
Insurance companies require that we collect all applicable deductible, specialist copay, and/or specialist 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. How we process payment depends primarily on whether you have met your yearly deductible yet.
If you have already met your yearly deductible: After you attend the appointment we will refund the $125 deposit, minus any specialist copay or coinsurance you are responsible for. We will then bill your insurance company for the remainder.
If you have not met your yearly deductible: We will apply the $125 toward your total appointment cost and process a second charge for the remainder. 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 for any reason: 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.
How We Charge Patients and Bill Their Insurance for Follow-Ups
We do not collect any deposit at booking for follow-up appointments. How we charge patients and bill their insurance remains contingent on whether they have already met their yearly deductible.
If you have already met your yearly deductible: Up to 24 hours prior to your appointment we will charge your payment method on file any applicable specialist copay or coinsurance requirements. After your appointment ends we will bill your insurance company for the remaining cost. In the event you do not attend the appointment we will convert the initial amount charged for copay or coinsurance towards a no-show fee. If that amount is less than $87.50 we will process a second charge to meet the $87.50 no-show requirement.
If you have not met your yearly deductible: Up to 24 hours prior to your appointment we will charge your payment method on file $87.50. If you do not attend the appointment this will be used as a no-show fee. If you attend the appointment, we will apply the $87.50 toward the total appointment cost and process a second charge for the remaining amount. We will then file a claim with your insurance company so they apply this amount towards your deductible.
Total cost when using insurance
Once your yearly deductible is met your only responsibility will be any applicable specialist copay or coinsurance requirements; insurance will cover the remaining cost (as long as you attend the appointment). If you have not yet met your yearly deductible, this section will explain how total appointment costs are determined when using insurance.
Short answer: The evaluation charge may be up to $500 but approximately averages closer to $300. Follow-ups may cost up to $250 but approximately averages closer to $175.
Detailed explanation: When we bill an in-network insurance policy for service there are a number of different billing codes or code combinations that may be used. These codes will vary based on several factors specific to your individual needs and the care delivered in your treatment. We will not know which codes are the most appropriate until the appointment is concluded and the documentation is finished. To further complicate matters, insurance reimbursement rates vary among insurers and insurance companies generally do not allow us to share reimbursement rates. We understand that this can be confusing and make it difficult for patients to appropriately budget. Therefore, to help our patients appropriately budget, we provide the following estimates and guarantees:
Total cost for an initial evaluation when using insurance will approximately average $300, but can be as high as $400. We ask all patients to have a total of $500 available to pay for their evaluation appointment. We will not seek actual reimbursement of greater than $500 for our initial evaluation service.
Total cost for our 30-minute follow-up appointments when using insurance will approximately average $175, but can be as high as $250. We ask all patients to have a total of $250 available to pay for their follow-up appointment. We will not seek actual reimbursement of greater than $250 for our follow-up service, unless the appointment requires significantly more time than scheduled. Appointment time includes other aspects of care delivery outside of face to face time, such as note review, documentation, and prescribing. Please keep in mind that the billing codes used for a follow-up can vary appointment to appointment and the cost will not always be the same.
After we have filed a claim with your insurance company they are able to review the appropriateness of the codes used and you should eventually receive an explanation of benefits (EOB) form from them.