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Co-Psych.com |
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Corvallis Psych' Clinic |
James Phelps, M.D. |
Insurance Matters
(Revised 7/2008)
Let me assure you, I know how difficult it can be dealing with insurance companies. After all, they have every incentive to make it slow or impossible to pay out on claims. So I do not burden you with this lightly. I just keep trying to tell myself that I didn't commit to billing insurance companies when I signed up to be a psychiatrist.
On this page you will find information about the following insurance programs. Some people prefer to simply pay an hourly rate and not deal with insurance at all.
A. Regence, Samaritan Choice, PacificSource, PacificCare, Providence
I am a preferred provider for these three, which means that I will bill them and accept your co-pay.** Please confirm that:
You do not require an authorization to see me (some
people with these insurances do. Don't get me started by asking why...)
If you do require an authorization, please get one before
we schedule an appointment. They pay me $10, no more, if you
don't.
Your policy covers mental health; and you still have some mental health benefit left.
(therapists use the same set of visits).
You don't have a deductible. (If you do, is it already paid this year, or will you need to pay me when you see me?)
**Co-pays: if your insurance pays a percentage of your costs, then your co-pay will vary depending on the length of visit. Please note that my computer calculates percentages based on my charges, not what your insurance company decides it is willing to pay me. Therefore the co-pay I charge you may be slightly greater than the one the insurance company says I'm supposed to be getting from you, like a dollar or two difference.
Ask that they send you a confirmation of all this, and bring that to your visit. Or they can fax it directly to me if you prefer (fax: 541 768 6560).
B. All Other Commercial Insurance except Lifewise
You will be asked to pay at the time of service and then present a receipt to your insurance. Please contact them now and ask how to submit receipts, and how much you will be reimbursed (this is likely to be as low as 50%). Remember, you have the option of paying for services at an hourly rate and not using your insurance. This results in leaving money in their pocket, I know-- very dissatisfying.
This particular company has a "miscellaneous claim form" on which they want you to submit charges. Here are instructions on how to complete that form, for the initial evaluation and subsequent visits.
Note that your diagnosis code may differ. That code can be found on the billing sheet you will receive from me.
What a mess, eh? Every company has a different form, a different procedure, and a different set of exceptions which will justify their refusal to pay. A friend of mine says it's like he went to the grocery store or to buy a carton of milk. And yet every single carton on the shelf has different price, and must be paid for in a different way (cash, Visa, barter, loan, deferred pay-back, charity) -- imagine what the cashier people would go through.
Initial evaluation
Line one: medical
Line 10: in the blank labeled number one, insert the diagnosis code from your billing sheet
Line 11: column a,
date column
B: 90801 column c: 1 [this refers to the code in line
10] column D: $260.
Line 12: 43-2006522 (EIN)
Line 13: $260
Line 14: zero
Line 15: $260
lower left box:
James Phelps, M.D.
3517 Samaritan Drive
Corvallis, OR 97330
541-829-9319
20 minute visits
Line one: medical
Line 10: in the blank labeled number one, insert the diagnosis code from your billing sheet
Line 11: column a,
date column
B: 90805 column c: 1 [this refers to the code in line
10] column D: $120.
Line 12: 43-2006522 (EIN)
Line 13: $120
Line 14: zero
Line 15: $120
lower left box:
James Phelps, M.D.
3517 Samaritan Drive
Corvallis, OR 97330
541-829-9319
50 minute visits
Line one: medical
Line 10: in the blank labeled number one, insert the diagnosis code from your billing sheet
Line 11: column a,
date column
B: 90807 column c: 1 [this refers to the code in line
10] column D: $180.
Line 12: 43-2006522 (EIN)
Line 13: $180
Line 14: zero
Line 15: $180
lower left box:
James Phelps, M.D.
3517 Samaritan Drive
Corvallis, OR 97330
541-829-9319
Dr. Phelps is no longer a Medicare provider (except for those Medicare patients who moved with him from Samaritan Mental Health in 2003, including those who went on Medicare after that time). If you wish to know why I have opted out, and how I make that up to society, read my essay about Medicare.