Dr. Lee has found that being out-of-network with insurances allows her to provide the highest level of care without compromising quality.
If you wish to submit to your insurance for reimbursement, she can provide an invoice that will contain information that gives many patients significant reimbursement.
The below is a list of questions she recommends you ask your insurer:
- Does my plan include out-of-network benefits for outpatient mental health services? (Yes/No.)
- What’s my Out-of-Network deductible for mental health services? (Dollar amount.)
- Must my Out-of-Network deductible be met before benefits apply? (Yes/No.)
- Is there a limit on out-of-pocket expenses per year? How much? (This is the maximum amount you will pay in a plan year; once you exceed this amount, your insurance will pay 100% of all healthcare expenses. This amount resets each year.)
- Do I have a limit on the number of outpatient mental health visits? (Yes/No.)
- Is preauthorization required for my medication and/or psychotherapy sessions? (Yes/No.)
- What is my co-pay? (Percentage.)
- What is my co-insurance? (Percentage.)
- What is the reimbursement rate for sessions (based on their CPT codes)
- Initial intake sessions (CPT code 90792)
- Medication sessions (CPT code 99213 or 99214)
- 30, 45, and 60 minute individual psychotherapy sessions (CPT codes 90833, 90836, and 90838, respectively)
- Group psychotherapy (CPT code 90853)
- What paperwork do I need to start a reimbursement claim, and where do I send it?
NO SURPRISES ACT
This notice applies to self-pay patients, which include the following: patients with no insurance coverage, patients who have insurance but do not intent to submit claims for reimbursement, patients with insurance that does not cover their services, and patients with insurance that does not offer any out of network coverage.
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 1 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 Dr. Ferguson at 917-287-0122.
The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided at https://openpaymentsdata.cms.gov. The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. At this time, Dr. Lee has no financial contributions from the above affiliate categories to report.
