Sarah A Tester, PhD, LMFT, LPC Marital and Family Therapist

                                              Clinical Member, American Association for Marriage and Family Therapy

                         1186 Fremaux Avenue Slidell, LA 70458         Phone: (985)643-5145   Fax: (985)643-6063

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ABOUT YOUR INSURANCE or INSURANCE 101

as Dr. Tester understands it. . .

 

ESTIMATING YOUR OUT OF POCKET EXPENSES

We will do our best to provide an estimated maximum cost for each office visit with Dr. Tester based on what your insurance company typically allows. The stars may align and you might talk with your insurance Customer Services Person who will quote a dollar amount that you will pay per session.

 

Be sure to ask Customer Service:

Do I have a deductible?

Do I have a co-pay?

Do I have a coinsurance payment?

What is the claims mailing address?

These payments are due at the time of service.

 

Boring Behavioral Health Insurance Lingo:

 

1) The first appointment is called a Psychiatric Diagnostic Evaluation--No Medical Services Procedure Code 90791, 45 minutes, and allows a higher payment.

 

Subsequent office visits with lower payment are called:

2) Individual Psychotherapy Procedure Code 90834, 45 minutes.

3) Family Psychotherapy Procedure Code 90847, 45 minutes.

4) Family Psychotherapy Without the Patient 90846, 45 minutes.

5) Crisis Psychotherapy 90839—may require a higher co-pay, 60 minutes.

Dr. Tester's office will make a good faith effort to obtain your insurance benefits and confirm that information with you. If the time and process getting this information becomes burdensome, we may ask you to obtain the information.

 

More Insurance Stuff Than You Wanted to Know but You Need to Know:

· You and Dr. Tester will each receive a statement called an Explanation of Benefits (EOB) for each service rendered in her office for which a claim is submitted.

· Your EOB Date of Service (DOS) and Procedure Code should match the super-bill you receive from Dr. Tester at the close of session.

· There may be occasions when none of us know what the exact dollar amount will be per service at the time of first appointment. DEDUCTIBLE is the amount of money that you have to pay out of pocket before the health insurance benefits kick in. Generally this is a yearly amount that has to be paid.

 

 

 

     CONTRACT YEAR: The contract year may be January 1 - December 31, or it may be a period such as October 1 – September 30.

 

The deductible may be for each individual covered or it can be a family deductible. Not all medical services you use and pay for will be applied to the deductible. NOTE: You may have opted to have a large deductible [ouch!] in order to lower your monthly insurance premium.

 

CO-PAY: Some services such as office visits, may be paid by a set amount called a co-pay, regardless of whether the deductible has been met.

 

CO-INSURANCE: Your share of the cost of a health service covered by your plan, may include a co-insurance. Once the annual deductible is satisfied, Coinsurance is the amount of the medical claim that the patient is responsible for paying. This is generally a percentage.

 

Example: Once the deductible has been satisfied, the insurance will pay for 80% of a surgery while you are responsible for the other 20%.

 

Make sure your policy has a Maximum Coinsurance Amount that limits your total out of pocket expenses for the contract year.

 

The universal claim form used by medical and mental health practitioners is called a CMS 1500. Most of Dr. Tester's claims are filed electronically.

 

EMPLOYEE ASSISTANCE PROGRAM BENEFITS (EAP):

PRE-AUTHORIZED SERVICES

 

* Your employer may offer through your benefits package a limited number of Outpatient Counseling Sessions, Procedure Code 99404 or 99404 HJ.

*  EAP benefits do not pay for psychological testing, a Psychiatrist's medical services, or the services of a Medical Psychologist.

*  Often, the EAP portion of your insurance benefits will be handled through a separate insurance company.

 

 

Your EAP sessions must be pre-authorized. At first appointment we need:

 

1) the name of the insurance company for EAP benefits and that telephone number.

2) an authorization number.

3) the address and/or fax number where claims are to be sent.

 

 

REPORTS, LETTERS, AND CONSULTATION

 

Dr. Tester's contract with an insurance company as a provider on a company's panel does not allow her to bill the insurance company for:

1) Time consulting other members of your treatment team.

2) Time preparing reports and letters pertaining to your treatment. You will be asked in advance to privately pay for reports, letters, and consultation on your behalf.

3) Missed appointments.

Sarah A Tester, PhD, LMFT, LPC Marital and Family Therapist

                                              Clinical Member, American Association for Marriage and Family Therapy

           1186 Fremaux Avenue Slidell, LA 70458         Phone: (985)643-5145   Fax: (985)643-6063       drtester@bellsouth.net

[Home] [Credentials] [1st Appointment] [Practice Declaration] [Cancellation Policy] [Insurance] [About Coverage]

Sarah A Tester, PhD, LMFT, LPC Marital and Family Therapist

                                              Clinical Member, American Association for Marriage and Family Therapy

           1186 Fremaux Avenue Slidell, LA 70458         Phone: (985)643-5145   Fax: (985)643-6063       drtester@bellsouth.net

[Home] [Credentials] [1st Appointment] [Practice Declaration] [Cancellation Policy] [Insurance] [About Coverage]

Sarah A Tester, PhD, LMFT, LPC Marital and Family Therapist

                                              Clinical Member, American Association for Marriage and Family Therapy

           1186 Fremaux Avenue Slidell, LA 70458         Phone: (985)643-5145   Fax: (985)643-6063       drtester@bellsouth.net

[Home] [Credentials] [1st Appointment] [Practice Declaration] [Cancellation Policy] [Insurance] [About Coverage]