Insurance and Fees

We offer comprehensive psychiatric services and are committed to offering quality accessible mental health care.
Our providers are in-network with most commercial insurances and we offer self-pay rates for those patients without insurance coverage.

Below are our in-network insurances as well as general insurance information to help you better understand your mental health coverage! This is not all-encompassing information and your policy may have criteria or benefits specific to you alone. ALWAYS call your insurance provider directly if you have policy-specific questions about your coverage!

Accepted Insurances

Aetna Commercial Policies
United Behavioral Health Care/Optum Commercial Policies
Cigna Florida

We are in network with these insurances but all have smaller
third-party policies within them that may be out-of-network.

Always call your insurance and verify your specific policy with our network status!

Policies We do NOT participate with:

Any Medicare or Medicaid type plan
Highmark Wholecare
PHCS/Multiplan
Magellan
Humana

Tricare
Kaiser Permanente
The Health Plan
Beacon Health Options
Worker’s Compensation

This is a list of some of the policies we have found
over the years that we are NOT in network with.

While we are in-network with the above listed
'parent' insurance companies- most insurance
companies have smaller policies within them that
are managed by Third Party Administrators.

We are not always in network with these third-party
policies, even if we are in network with the parent
company.

As we do not have the ability to check the
specifics of every patient's policy it is YOUR
responsibility to call your insurance and check to
see if we are in-network for your specific plan!

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Medicare or Medicaid Policies

We are not a participating Medicare or Medicaid provider.
We are unable to see any patients with these policies, even as secondary or subsidiary policies.

Insurance FAQ

Insurance can be confusing for even the most savvy of patients. Below are a few terms and facts to give you the tools to have an informed discussion with your insurance carrier about your benefits and coverage

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A deductible is what you pay annually for health services before your insurance company pays its share. For instance, if you have a deductible of $1,000, your insurance plan might not start covering its share of your bills until you’ve paid $1,000 for healthcare in a given year. This does not mean the services are not covered.

Your copay is the amount you owe each time you receive certain types of medical care.

Depending on your policy these can vary from doctor to doctor. For example, you may have to pay a $30 copay for each visit to your PCP and $60 for each visit to a specialist, like your psychiatrist or cardiologist. Most copays do not count towards your deductible. You will need to find out from your insurance carrier if yours do.

After you’ve met your deductible for the year you may have a coinsurance. That’s the percentage of your medical expenses that you are responsible for. For example, once you meet your $1,000 deductible your coinsurance would be 20% from there on. That means you would pay $20 of a $100 bill and the insurance company would pay the other $80.

This does not mean that the services aren’t covered- just that your insurance carrier is only responsible for a percentage, according to your policy. Some policies do not have a coinsurance, in which case your insurance would cover 100% after your deductible is paid.

Your out-of-pocket-maximum is the most you’ll ever be required to pay each year towards your medical bills. This includes your deductible, copays, and coinsurance.

Say your OOP Max is $5,000. This means that once you have paid $5,000- between your deductible, your copays, and any coinsurance you have- your insurance company will then cover 100% of the costs for any other services until your policy resets at the end of it’s term.

Premiums aren’t included in the out-of-pocket maximum and neither are extra services or equipment such as hearing aids and acupuncture. If your plan distinguishes between in-network and out-of-network providers, out-of-network bills may not count toward your out-of-pocket maximum either, so review your policy carefully.

The allowed amount is the amount that the insurance company has determined to be a fair price for a given medical treatment. If your doctor is part of that health plan's network, then they have agreed to that specific allowed amount, and the provider agrees to write off any charges above that amount.

For instance your doctor may have priced a procedure at $200, but the insurance company has only agreed to pay $75 for that procedure. This means that the provider and insurance will adjust and write off $125, leaving the insurance to only pay your provider $75 for the procedure.

Your health plan may have different allowed amounts for the same service, since their contracts vary from one medical provider to another.

EOB stands for Explanation of Benefits. This is a document sent to you by your insurance to let you know a claim has been processed. The most important thing for you to remember is that an EOB is NOT a bill. It is a document letting you know which healthcare provider has filed a claim on your behalf, what it was for, whether it was approved, and how much your insurance is covering.

You should always review your EOB to make sure it’s correct and contact your insurance’s claims department with any questions.

The ongoing amount that must be paid for your health plan. You and/or your employer usually pay it monthly, quarterly or yearly.
The premium may not be the only amount you pay for insurance coverage. Typically, you will also have a copay or deductible amount.

Costs and Fees

All providers have practice-specific fees. We want you to know ahead of time what kind of fees you can expect as a patient in our clinic so you can make informed decisions regarding your healthcare. Medical care can be stressful enough, we don't want hidden fees and surprise bills to add to that!
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There are many reasons some patients self pay for their healthcare, whether they choose to not file claims with their insurance or are just out of network.

Because of the range of services we offer, there can be variation in out-of-pocket costs, depending on your specific treatment plan. Below are the average estimates for out-of-pocket costs should you need to self pay for our services.

New Patient Evaluation: $485.00
Follow-up Visits: $320

Per our treatment consent we require 48-business-hours notice to cancel an appointment without fees. Any appointment canceled with less than 48-business-hours notice is subject to a late cancel fee ($300 for new patient evaluations and $150 for follow-up appointments), this applies for no-shows as well. These fees are collected from the credit card on file immediately upon cancelation and are not reimbursed by insurance.

No show/Late Cx fees are assessed not only to show the value of your provider's time, but also to underscore the importance of keeping regular appointments. While our policy is very strict we do understand that emergencies happen. If there were emergent or extenuating circumstances which kept you from keeping your appointment we would ask that you reach out to our practice manager to discuss what can be done regarding the fee.

For safety reasons all patients on medications must be scheduled for consistent follow up appointments and patients who do not consistently attend appointments will be charged a $70 fee for filling outside of an appointment. This fee is not a guarantee that refills can be sent- as some medications cannot be safely refilled if a patient is not consistently following up with their provider. If you are looking for medications without follow-up we may not be the best practice for your needs.
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Medication refills sent outside of a scheduled appointment due to canceling or not attending your last scheduled appointment are subject to a $70 medication refill fee. This fee is not reimbursed by insurance and is not meant to charge patients for all refills that are requested. Patients are required to have ongoing follow-up treatment to continue medication management with the practice to ensure effective and safe treatment of mental health needs.

All forms completed outside of a scheduled appointment are subject to a minimum $100 fee for completion- and very extensive documents may have higher fees associated based upon the extended time needed by the provider to complete them. These documents include ESA letters, disability or FMLA forms, and work clearances. Fees will be charged to the card we have on file and are not reimbursed by insurance.

While all our providers are dedicated to their patients and field, we value our provider's time away from work as well. It is unfair to expect our providers to spend large amounts of time completing paperwork after hours, taking them away from their homes, families, and their own self-care. We encourage patients to schedule an appointment and discuss and review these documents with their provider instead. This allows the patient and provider to thoroughly review the documentation needed and avoid these additional fees.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item.

You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 412-407-7876

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