1. I am contracted/in network with your insurance company, and you would like to coordinate payment through them.
2. I am not contracted with your insurance company, so you will pay me directly, and I will provide you with a “superbill” which is a receipt you may give your insurance company and they may reimburse you for part of my fee. Reimbursement in this way is not an option if your insurance is a Washington State Medicaid plan.
3. I am contracted with your insurance company, but you do not want them to be involved in your psychiatric care (using your benefits means that they will have record of your diagnosis, and they may request details of your treatment to verify that they are paying for valid care), so you will pay me directly and not submit any information to your insurance company about your treatment.
I am contracted, “In Network,” with the following insurance companies:
Blue Cross Blue Shield
(By January 2020) Aetna
First Choice Health
If you choose to pay with insurance, then my rates are determined by your insurance company. See below for a sample list of codes if you would like to check how much your insurance might charge for my services.
Being in network with your insurance company does not mean that you will not have to pay for your appointments. Often, appointments with me will not be covered until you have reached your deductible, and even then, will often be covered at a partial rate until you have reached your maximum out of pocket charge.
Direct Pay Rates
Initial assessment and evaluation (60-90 min): $350.
Medication management follow up (20-40 min): $150
Psychotherapy/Parent Management Therapy (50-60 min): $200
These rates are subject to change based on the exact nature of your treatment.
Insurance companies use two codes to determine what they will pay for a medical service:
1) A billing (CPT) code, which describes the type of appointment and services provided. For example, 90792 is a general code for a psychiatric evaluation.
2) A diagnosis code, which tells them the general reason why you are receiving psychiatric treatment. These are similar to DSM 5 diagnoses, but not exactly the same. For example, F41.1 is Generalized Anxiety Disorder.
You can contact your insurance company before your appointment to find out how much they will charge/reimburse for the following billing/diagnostic codes:
Intake Appointment Codes: 99204; 99205; 90792
Follow Up Appointments: 99212, 99213, 99214, 99215
Psychotherapy Codes: 90833, 90836, 90838
Additional codes: 90785
A medication management visit will often be a 99213-5 with an additional 90833 code, depending on the length and complexity of the visit. A psychotherapy visit will often be a 99212-4 + 90836 or 90838, again, depending on the complexity and length of the visit.
This is not an exhaustive list of codes, but will give you an idea of the range of costs/reimbursement.