FOR MOBILE USERS: SITE MENU IS DISPLYAED AS 3 LINES
Your time is valuable! Our time together is valuable! To help keep your session for what it is for—therapy—every consideration has been made in creating a process for payments and billing statements that is as easy as possible.
Eastside Insight accepts the following payment options:
Fees are due at time of service. So that no extra time is spent collecting payment at the start of session, the card you have on file will be used to process your payment. Payments are typically processed in 1-2 business days. If you wish to use a different payment option, please indicate this at the beginning of session. You can also self-activate a payment, at any time, through the Patient Portal—a HIPAA-compliant web-based service for all your clerical needs. New clients will be provided a link to set up a secure account for the Patient Portal during the initial scheduling process.
To maximize the allotment of therapy time, you can access your bills through the online Patient Portal. Here you can print off receipts, superbills for out-of-pocket network insurance reimbursement, and download a history of statements. This paperless option also allows you to save these documents on your own computer for your bookkeeping needs, or when wanting to submit electronically to a third party, etc. If you need a paper statement, and encounter trouble doing this through the Patient Portal, please indicate this at the start of your session, as this will take several minutes to generate, given that session fees are typically not entered for 1 to 2 days following your visit.
I support a Private Pay Model in my solo practice. Meaning my services are not limited to or dictated by Insurance Companies. An in-network provider is contracted to offer services under the rates and stipulations set forth by the insurance plan; an out-of-network provider is not. When seeing a licensed practitioner not in-network, insurance will often reimburse for a portion of the out-of-pocket expenses, typically at 60%. PPO & POS plans commonly endorse this practice; HMOs usually only for emergency services.
Financial Hardship: I offer a flat rate, rather than increasing rates based on type of service. This fee reflects the average rate, for the lowest cost of service offered in the area. I also hold pro bono (free) slots. These are commonly full, but I do maintain a waiting list for those seeking this service.
The choices we make in healthcare shape health.
If you would like to learn more about insurance vs private pay models, you can do so in my blog post below:
Necessity – The Difference of Insurance and Private Pay in Therapy.
Full payment is due at time of service, as my fee is not based on insurance reimbursement, nor are refunds or adjustments made for services not covered by your insurance. However, I am happy to help aid you in this process. First you will need to call the number located on the back of your insurance card and inquire about the following:
Out-of-Network Benefits: Does your insurance plan offer out-of-network benefits?
Reimbursement Rate: Fee-for-service reimbursement is often 80% for in-network, and 60% for out-of-network, but every plan is different, so please ask for the reimbursement rate specific to your plan.
Deductible: Insurance commonly has a deductible that needs to be met prior to receiving reimbursement. If the deductible is large, or perhaps you have an HSA or FSA for such expenses, using your out-of-pocket benefits in this way makes a lot of sense. Knowing this information can help financially plan your care.
Services: To help maximize your out-of-network reimbursements, I have compiled a list of the most used and accepted CPT codes in psychotherapy (click tab below). CPT stands for Current Procedural Terminology. It is a medical code used in billing practices and by other accredited establishments to report the medical and diagnostic procedures and services of licensed healthcare professionals. Just because a CPT code exists though, does not mean your insurance will cover this service. When you review your benefits with your insurance agent, please also discuss these CPT codes to see which ones are covered, at what rate, as well as if there are any caps on number of visits or session lengths.
Diagnosis: Insurance is based on medical necessity, so conditions that are less chronic or acute, or deemed as pre-existing, by your plan, may not be covered. It may behoove you to know what diagnoses are covered up front, or what is deemed as pre-existing. Some practitioners may opt to provide an alternative diagnosis that is covered, so that you can still receive services, but this constitutes insurance fraud and hides the extent of limitations in our healthcare system.
I use behavioral health software that allows me to both create and electronically submit what is known as a ‘superbill’ on your behalf to insurance, saving you the step of filling out the insurance claim forms and mailing them in. Payments also tend to be processed faster, like 1-2 weeks, when submitted through a provider. A superbill lists the CPT codes associated with the services rendered, diagnosis, place of where you received care, as well as the practitioner’s licensing information. Given that I am not charging your insurance, it means I do not have to provide progress notes about what took place in therapy, and in most cases, the criteria for diagnosis. The reimbursement check will be sent directly to you. Moreover, I will not be notified of any denials to your claim if they occur, as I am not charging your insurance, but rather submitting a bill for you. You will need to follow up with your insurance directly if problems arise.
Copyright © 2021 Eastside Insight - All Rights Reserved.