WHAT IS OUT OF NETWORK?:
Dr. DePalma is an “out of network Physician” - this means that he does not contract with insurance plans.
OK, SO WHAT DOES THIS MEAN FOR ME? CAN I STILL GET APPOINTMENTS PAID FOR?
Many of our patients have been able to get part or all of fees paid by insurance as "out of network". Please ask them if this is important to you (see below)
HOW THIS WORKS:
HOW THIS WORKS:
- An invoice with appropriate diagnostic information will be provided upon request (MAKE SURE TO ASK FOR THIS) so patients may submit for reimbursement to insurance company by sending to the address on the back of your insurance card. (Dr DePalma will provide you with this invoice at any time so if you forgot to ask at time of appointment feel free to ask for it at a later point using the SUPERBILL REQUEST TOOL HERE.)
- Fees are due in full on arrival for appointment.
HOW TO FIND OUT IF YOUR INSURANCE COMPANY WILL REIMBURSE AND IF SO, HOW MUCH THEY WILL:
Three different ways to find Out How Much Your Health Insurance Company Will Reimburse:
1. Check your health insurance brochure to see if it lists "out of network" coverage. On average this is more common with PPO plans than HMO plans.
2. Before the appointment you can call your health insurance company BY DIALING THE NUMBER ON THE BACK OF YOUR INSURANCE CARD and ask the following:
a) Does my plan include any "out of network coverage" for out of network Psychiatrists?
b) If so, how much you will be reimbursed for the following CPT (Current Procedural Terminology) Codes?:
90792 (initial consultation)
99214 (30 min follow up)
99215+90838 (60 minute follow up with therapy)
3. If you are not sure whether this is covered in part or whole and do not want to call your insurance company you may decide to submit an invoice and see how much reimbursement you receive if any. Also read the E.O.B (Explanation of Benefits) that is sent back to you by your insurance company. Health insurance companies are required by law either to pay the claim, or tell you why they are not going to pay, within 30 days.
1. Check your health insurance brochure to see if it lists "out of network" coverage. On average this is more common with PPO plans than HMO plans.
2. Before the appointment you can call your health insurance company BY DIALING THE NUMBER ON THE BACK OF YOUR INSURANCE CARD and ask the following:
a) Does my plan include any "out of network coverage" for out of network Psychiatrists?
b) If so, how much you will be reimbursed for the following CPT (Current Procedural Terminology) Codes?:
90792 (initial consultation)
99214 (30 min follow up)
99215+90838 (60 minute follow up with therapy)
3. If you are not sure whether this is covered in part or whole and do not want to call your insurance company you may decide to submit an invoice and see how much reimbursement you receive if any. Also read the E.O.B (Explanation of Benefits) that is sent back to you by your insurance company. Health insurance companies are required by law either to pay the claim, or tell you why they are not going to pay, within 30 days.
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MORE INFORMATION:
lOther Informative links:
http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/difference-between-in-network-out-of-network-benefits.html
https://www.uhc.com/legal/information-on-payment-of-out-of-network-benefits
https://www.mhn.com/content/understanding-your-out-of-network-benefits
http://www.bcbsm.com/index/health-insurance-help/faqs/topics/how-health-insurance-works/difference-between-in-network-out-of-network-benefits.html
https://www.uhc.com/legal/information-on-payment-of-out-of-network-benefits
https://www.mhn.com/content/understanding-your-out-of-network-benefits