Rates:
$300
combined flat rate fee includes the first two sessions. This includes a
90-120 minute evaluation and a 60 minute first followup appointment.
Subsequent sessions are charged at a $190 per hour rate, most typically $95 for a 30 minute appointment.
Payments:
Payment
is expected at the time of the appointment. The combined flat rate fee
would be paid at the first of the two included sessions.
Insurance:
Information is provided below for the following health plans:
Aetna
Blue Cross Blue Shield
Fallon
Harvard Pilgrim
Neighborhood
Tufts
I
am an out of network provider. Most clients with PPO style health
plans and some others with non PPO style plans will be able to arrange
for some reimbursement from their health insurers.
Getting the right answers and the answers that are right for you:
Please note that the information on this page may change
with time and even with which customer service person answers your call.
Always remember to ask for their supervisor if the
information the customer service representative is giving you seems to be in error or to
not make sense.
Also, there is always an appeals process if you are not
satisfied with the answers and decisions of your insurer.
Aetna procedures for reimbursement for use of out of network
providers:
PPO members need to call 1-800-872-3862.
o
PPO members do have out of network benefits.
o
PPO members do not need referrals.
o
The deadline for submitting claims depends on
their specific policy, but is usually 3 years and 90 days.
o
Aetna’s standard is to provide reimbursement within
30 days.
o
PPO members only need to submit the bill.
HMO members need to call the number on the back
of their card for answers to questions.
o
Regarding if referral pre-approval is required
for out of network services.
o
Deadlines for submitting claims.
o
Reimbursement timeline.
o
Claim requirements.
Blue Cross Blue Shield procedures for reimbursement for use
of out of network providers:
PPO members need to call member services at 1-888-211-4521.
o
PPO members do have out of network benefits.
o
PPO members do not need referrals.
o
The deadline for submitting claims depends on
their specific policy, but is usually 2 years.
o Blue
Cross Blue Shield’s standard is to provide reimbursement within 30 days.
o
I will give the member the information that is
required in the claim form that the member summits to Blue Cross Blue Shield.
o
The member needs to submit all this
documentation through member services.
HMO plans ordinarily have no out-of-network
benefits unless the provider is contracted or an appeal is successfully
approved. I am not a contracted provider
at this time.
Fallon Community Health procedures for reimbursement for use of out of network
providers:
PPO members call Beacon Health Strategies at
1-800-414-2820.
o
PPO members do have out of network benefits.
o
PPO members do not need referrals.
o
Members do not receive reimbursement—rather, the
provider receives payment from Beacon Health Strategies.
o
A member that wishes to me would call Beacon
Health Strategies. Beacon Health
Strategies would then contact the me and set up a single case agreement.·
o Non-PPO members do not have benefits to go out of network UNLESS they meet criteria to go out of network.
Criteria include the following: language barrier, inability to find a
provider in network, etc. If the member
does meet the criteria to go out of network, the procedure listed above would
be followed to set up a single case agreement between Beacon Health Strategies and
me.
Harvard Pilgrim procedures for reimbursement for use of out
of network providers:
PPO members need to call the customer service
division. Each plan has its own customer
service division. The phone number for
the standard line is: 1-800-333-8724.
o
PPO members do have out of network benefits.
o
PPO members may need referrals. The policy
differs with specific benefit plans.
o
The deadline for submitting claims depends on
their specific policy.
o
Reimbursement timeline depends on their specific
policy.
HMO plans ordinarily have no out-of-network
benefits unless an appeal is successfully approved. United Behavioral Health
handles mental health benefits for Harvard Pilgrim members. Phone number for UBH: 888-777-4742. Any appeal would be made through them.
Neighborhood procedures for reimbursement for use of out of network
providers:
PPO members call Beacon Health Strategies at
1-800-414-2820.
o
PPO members do have out of network benefits.
o
PPO members do not need referrals.
o
Members do not receive reimbursement—rather, the
provider receives payment from Beacon Health Strategies.
o
A member that wishes to me would call Beacon
Health Strategies. Beacon Health
Strategies would then contact the me and set up a single case agreement.·
Non-PPO members do not have benefits to go out
of network UNLESS they meet criteria to go out of network. Criteria include the following: language
barrier, inability to find a provider in network, etc. If the member does meet the criteria to go
out of network, the procedure listed above would be followed to set up a single
case agreement between Beacon Health Strategies and me.
Tufts procedures for reimbursement for use of out of network
providers:
PPO and HMO
o
There are no distinctions that are always true for
a PPO member versus a regular member, most of the distinctions are
plan-specific.
o
Some members have out-of-network benefits, and
some do not.
o
For members without out-of-network benefits,
there is no coverage at all (unless appealed).
For members with out-of-network benefits
o
The mental health division phone number is
1-800-208-9565.
o
Some members need referrals from primary care
doctors and some do not—it depends on their individual plans.
o
There are different forms for different plans.
o
Forms need to be submitted within one year.
o
The forms list all of the information that needs
to be included in order to submit a claim.
I will provide any required information to the member that they need to
complete their claim form.
o
Tufts’ standard is to provide reimbursement within
6-8 weeks.
