Billing Questions and Answers
Most Billing and Fee questions are answered below.
Those marked with *** are questions that merit an email to be sent to billing to obtain resolution. We ask that when you compose your email to us, that it includes the patients name, date of birth, email, and phone number.
Q. How will I be billed for services?
A. You will receive an itemized bill after each session, detailing the services provided. If you have insurance, we will submit the claim on your behalf. Any balance due after insurance is applied will be your responsibility.
Q. Are there any hidden fees or additional costs I should be aware of?
A. We strive to be transparent with our billing. All fees are discussed upfront during your initial consultation. However, please be aware that missed appointments or late cancellations may incur additional fees as per our cancellation policy.
Q. ** Can I set up a payment plan if I can’t pay my bill in full?
A. Yes, we offer payment plans for clients who need to spread out their payments. Please contact our billing department to discuss your options.
Q. I received a bill and it indicates I have a balance to pay. I have insurance. My insurance is supposed to pay.
A. You may have received a bill/statement before your insurance paid its share and possibly before your copay was credited to your account. Please wait for another month or two. Most insurances pay within 60 days.
Q. My copay should only be $10. That’s what I pay at my primary care doctor’s office. I was charged more. Why?
A. Copays for mental health services are considered by some insurers to be a specialty copay
which is typically a higher fee than the copay for primary care providers.
Q. Why did the front desk say I owed payment in full today?
A. Most insurances have an annual deductible that starts in January (PEHP starts in July). Once you have used services and paid for services that cost up to your deductible amount, then your insurance will start to pay its share. Until then, you will owe the balance in full.
Q. How do I know what my deductible is?
A. You may call your insurance company on the phone number which is on the back of your insurance cared, OR someone at our front desk may be able to use a “portal” which gives us this information.
Q. Why do I have to see my medication provider face-to-face in person at the office? I signed up for tele-health.
A. Federal law requires your provider to have one encounter, face-to-face in person in office every year (12 calendar months) for clients who are receiving level 2 medications (example: Adderall, Xanax, etc.).
Q. My statement has services billed on days that I was not even at the clinic.
A. Evaluation services that require scoring, interpretation, or written reports of results (for example new psychological evaluations) are billed on different days than the in person encounters with the provider.
Q. I just started attending services here. When should I pay? I get the bill/statement and it says nothing was paid.
A. Whenever possible, keep up with your copays. Place a credit card on file to pay your copays, or pay in full before your deductible is met. Online use “Bill Pay” option on our website: www.WeCanHelpOut.com
Q. I’ve been receiving tele-health services and I always paid my copay. I found out that, if I do tele-health, I do not have a copay. Do I get my money back?
A. If you paid copays and your insurance waives copay responsibilities, you will receive a refund in a future billing cycle. Usually, it takes two months.
Q. **I want to pay cash and not use my insurance. What are the fees for the services you provide?
A. Cash pay rates vary from provider to provider. Ask your provider for their cash rate. Unless it is a unique service or one that requires a report used in court, our fees match the discounted rates of your insurance plan, or we use the “Select Health” fee schedule to determine a fair discounted rate.
Q. ***** I was told that the services I received would only cost a copay. I received a big bill. My insurance indicates that the services billed were denied. I thought and was told that the services were pre-authorized and covered.
A. Please have your provider or front desk staff compose an email to billing with this question. Be sure the client’s name, date of birth, insurance information is correct in our system. We can show you what information we have. The email to billing should Also have your email and preferred cell phone number. Sometimes insurance pre-authorizations are not communicated to the “claims denial” people at the same insurance company. When we do a pre-authorization, we record everything who we spoke with at your insurance company, the date and the time of day, authorization number. We document and quote what the pre-authorization agent says to us and we also record the authorization number they give us and what services the authorization is for.
Q. I received a statement (a bill) and I received a record of services and payments that my insurance company paid. There was a provider name on it, not my provider, indicating services rendered by them. Why is that?
A. Some services are clinic based or “incident to” a supervising provider. The person on your insurance’s “explanation of benefits’ is a supervising clinician. Your services are billed under that person.
Q. I participated in two services on the same day. My insurance only covered one of the services.
A. Some insurances don’t allow two outpatient services on the same day. Have your provider or the front desk prepare an email to billing. We will first try to appeal the denial. If that doesn’t work, then we will re-bill the more expensive service and retract the less expensive service. We will try to work it out in your favor.
Q. My statement and insurance company denied the payment of the Intensive Outpatient Program Service that was billed but paid for a counseling session which occurred the same day.
A. See above response. Be sure that you do not schedule with a provider for therapy or medical services on the same day as attending the Intensive Outpatient Program.
Q. My statement and insurance explanation indicates two types of service codes associated with each other.
A. Spravato (esketamine) or medication management often indicates a main service and an “add on” psychotherapy or monitoring code , which is often added to account for these services.
Q. Who should I contact if I have concerns about my treatment or need clarification?
A. We encourage open communication. If you have any concerns or need clarification about your treatment plan, please don’t hesitate to reach out to your provider directly or contact our office for assistance.
Q. What should I do if I feel that my concerns aren’t being taken seriously by staff?
A. Your experience and satisfaction are very important to us. If you feel that your concerns are not being addressed appropriately, please ask to speak to a manager who will work with you to resolve the issue.