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Co-Psych.com |
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Corvallis Psych' Clinic |
James Phelps, M.D. |
Paying For Services Here
(revised Jan. 2005)
Please read the "simple version" below. Beyond that, I can explain these changes next time we meet. For those of you who wish, more details are offered, if you don't find it all too confusing.
And for new patients, I'd recommend reading all the way through this.
Here are the changes from my prior practice arrangements at Samaritan Mental Health, then a brief explanation:
Why is this happening? Because insurance companies -- for understandable reasons, through decisions by well-intentioned people -- have added many layers of complexity to the process of paying for services. Overall, about as much energy is spent managing these layers as is spent providing the services in the first place, perhaps more.
Therefore, at Co-Psych I am trying to simplify things. There may be a way in which this will improve matters for you, not just for me. However, this change will obviously turn over to you much of the process of dealing with your insurance company, if you have one. That will complicate your life, at least at first. During that time I'll try to help you with the process.
The other major change is that I may charge for all my services, not just the ones that insurance companies reimburse. Please note that with some care, you can avoid the need for these services entirely, and I can help you with that. If you show a good-faith effort to do what you can to keep these matters out of my hands, or make it easy for me to respond with a minimum of time, then I will not likely charge at all. Other matters I may ask you to work with me on, when you are here in my office, as taking care of some issues can be part of therapy and charged to your insurance.
Services for which you may be charged include:
If you need something Here are some hints on how to keep these costs down.
Beyond this, I can explain things further at your next visit. Read on if you'd like more more details now.
At present insurance companies only pay for 3 different services that I provide, because I always combine psychotherapy of one form or another in any visit greater than 10 minutes (more on that); and because I rarely get to do psychotherapy alone. Other providers can do that, so I generally see only folks who need a medication option.
Here are those 3 services from the insurance point of view (after an initial interview):
| Code | Service | Time according to insurance |
| 90807 | Psychotherapy and medication management | 45-50 minutes |
| 90805 | Psychotherapy and medication management | 20-25 minutes |
| 90806 | Medication management | 10-15 minutes |
For the moment, if you are using your insurance, we'll have to use one of these 3 codes, and thus our visit time is pre-determined. There is more information below on how this can be varied if we are not billing insurance.
For most major Oregon insurers, I've been able to work out a billing arrangement. Here's the current list.
Otherwise, you will be asked to pay for services on the day you receive them. Most of my current patients can afford this, at least until their insurance reimbursement comes back. Some will pay without insurance reimbursement. But for those of you who cannot even sometimes afford your medication co-payments, and I generally know who that is, there will be an option. In those cases, I will keep track of what you owe for services. When your insurance reimbursement comes in, you can pay me then. This is an honor system it will be easy to violate. If I'm feeling violated, I'll let you know.
If you really can't afford to pay for the services you are receiving, such as when your limited insurance benefit runs out, you can talk to me about how this can be managed. If you end up with no insurance and cannot afford to pay "out-of-pocket", then you'll be referred to places that offer care at low- or no charge. There will be an exception for Medicare patients, whom I will see for reduced fees because of my choice to "opt out" of Medicare entirely. Read here about more Medicare issues.
New Concept: Pay for what you use
The following section applies to patients who are paying without billing their insurance at all, generally for people whom I know fairly well from working together over months, and for one-time consultations. It also includes people whose insurance benefits have run out and thus are forced into the position of paying for what they use.
Imagine if you could provide us all the information needed for quality medication decision-making in advance. Imagine if you could read about your medication options; their risks, side effects, and potential benefits; and end up knowing more about all that than if you heard it from the doctor directly.
Imagine if you could participate in the preparation and maintenance of your own medical record (a copy of the one Co-Psych maintains). Imagine if you were able to track your symptoms easily over time so that any changes would be obvious (your doctor would need little if any additional discussion to know how things have been going, for example). Imagine if we were able to insert your tracking data right into your medical record, and give you a graphed copy of your results.
Notice that none of this would be charged, because it would take no or minimal time to manage. Over time we are going to develop that system at Co-Psych. Maybe insurance companies will decide that paying for less services, when less services are adequate because you're doing much of the work, is worth arranging.
How it works
A. Consultations: the more preparation you can do in advance, the more we can spend our time focused on your needs (as opposed to the usual and necessary gathering of information). See the "Sending information in advance" guidelines. Then read the steps outlined for new patients. Then, if you wish, email a request for a consultation visit. Here are the rates for this service.
B. Follow-up visits where you and your medication issues are well known:
You help provide the information we together will need to make decisions; written in advance; in a format we can put directly into your medical record (specific instructions). Send it in by email (here are email guidelines including security issues and options for maintaining privacy). If you don't already have an appointment, we might use your information to decide if you need to come in, or if we can handle things by email.
Whenever possible, we'll conduct this process by email, as long as that is adequate and safe. You'll probably need to be seen directly at least once a year, and much more often if your condition is complex and we need to do some hard decision-making together. (I get to participate in the decision about what's adequate and safe, by the way...).
If we decide together that you're coming in, or if we had already set an appointment, we'll use the information you sent or bring in. Where possible, we can go for minimal additional information exchange (usually it only takes about a minute to size you up, especially if we've been at this many times before) and cut straight to the treatment options. Wherever possible you'll be referred to internet information resources to read about the risks; side effects; and possible benefits of the treatment options we identified.
When you decide on which approach we should take, you email your decision (or we can have further discussion about it via email; if necessary, you could of course come back in). Your prescription is fax'd to your pharmacy; your specific instructions are emailed to you, including when we need further follow-up.
Email charges will be held until your next in-person visit, or can be mailed. You will be asked to pay at the time of service for in-person visits.
Paying for What You Use
Under this plan, all services are charged by the minute. If I can turn over a task to you, like preparing copies of your record for forwarding to your primary care doctor, we will.
For example: let's say you're taking lithium. When you go to the lab for a lithium level, you ask the lab to send you a copy. You log it into an ongoing "flow sheet", and email a copy for our next electronic or direct meeting. While we're meeting, the new flow sheet updates the previous one in your electronic medical record, at minimal or no additional "minutes".
Psychotherapy
Of course this is possible as well. The difference from using insurance-based "codes" is that together we will choose just how much time to devote to this each meeting. You can schedule a 20 minute appointment and use only 15 minutes, then pay for only 15 minutes. I can always find something else to do with that extra 5 -- or 10, or 15 -- minutes.
There will be no psychotherapy by email, however. That is a boundary it may be good to maintain. Email and voicemail will be reserved for questions, and medication concerns. For anything requiring even just good listening (see Style), you'll be directed to make an appointment.
How much does this cost?
Finally, the actual charges -- which have not been increased for 1 and a half years so far, as of Jan 2005 -- part of my personal tiny effort to hold down increasing health care costs.