FEES & INSURANCE

 

FEES

    Our fees are as follows:
Service Length Fee
Initial evaluation
1 1/4 hours
$300
Individual therapy
55 minutes
$150
Medication visit
20 minutes
$100
Psychiatry therapy
60 minutes
$150

These fees reflect the amount of time your child and you actually see the provider. Sadly, most adult & child psychiatrists only see patients for brief medication visits (~10 minutes). We have chosen to establish longer periods of time for patients to review concerns in detail.

We contract with several insurance companies as listed below.

 

iNSURANCES ACCEPTED (CLICK TO GO TO iNSURER):

 

Payments:

Insurance cards, co-payments, and co-insurances are expected at the time of service. Please make sure you bring proof of insurance to the visit; If you have no proof of insurance, you will be asked to pay the full fee at the time of your visit. For your convenience, we accept VISA, MasterCard, Discover, and American Express.

We list above the insurance plans with which we have established a contract and which we accept. If you have one of these insurance plans, go to #1 below (for families who have an insurance plan which we accept). Otherwise, go to #2 (for families who do not have an insurance plan we accept).

  1. For families with an insurance plan that we accept: All plans are “plan” specific and pay differently. It is the patients’ responsibility to know their plan payment details. Please call your insurer to confirm that your child will be covered by our practice before your visit and that no special referrals are needed. Look on the back of your insurance card and read it carefully for this contact information. Sometimes the company and phone number for mental health (or behavioral health) benefits are different than they are for physical health insurance. If so, contact the mental health (behavioral health) company. We also suggest you write down their answer along with the name of the person you talk to and the date & time of the call. Health benefits are so complex this will protect you if there is a conflict about a bill in the future. You are only responsible for paying the copay at the time of the visit. Note: The remaining information on this screen does not apply to you.
  2. For families who do not have an insurance plan which we accept: All health plans agreements are between the patient and their insurance carrier. As a courtesy, we will submit charges for services to your insurance company before billing you directly. However, any balance not paid by your insurance company will be your responsibility in full. Most insurance companies will give the family back part of the cost for sevices if the proper steps are followed (see below). If our fee or payment would cause a hardship for your family, please let us know beforehand - we will be happy to arrange a payment plan. Please talk with us before the visit.

 

ADDITIONAL INFORMATION FOR INSURANCE REIMBURSEMENT FOR PLANS NOT ACCEPTED IN OUR PRACTICE: (The information which follows is meant to help you earn back the maximum amount of money. You may want to print this entire page to have it for review).

On most insurance plans, patients can see doctors who are either:

  • "in-network" (i.e. the plan has negotiated a specific fee with that doctor; the plan pays the full fee minus a copay) or
  • "out-of-network" (i.e. the plan has no specific contract with that doctor, the plan pays an amount usually less than the full fee and the patient pays the remainder).

Usually, you can receive partial reimbursement for out-of-network plans, though not always. You should check with your insurer before the visit to verify your responsibility. For out-of-network insurers we require full payment at the time of the visit; we do not bill insurers with whom we do not have a contract (as listed above). We will give you a receipt which you can turn in to your insurer. Please note, your insurer may require information in addition to the receipt. We are willing to supply reasonable additional information required by your insurer. If that paperwork becomes excessive there will be an additional charge since the provider (doctor) must take time away from other children to complete it.

There is one potential way for out-of-network families to be covered fully by their insurance companies. They can request a "single case agreement". Essentially this is a one-of-a-kind contract between our office and your insurance company in which your insurance company agrees with us to create an in-network contract for your child. You will need to inquire about this option; your insurance company will not offer it up front since they encourage families to seek care from providers (doctors) who see large numbers of their customers. Since you are asking for an exception, you will need reasons to justify this request. Here are some valid reasons:

  • Dr. Reynolds is the only child psychiatrist in full-time practice in Stark County, Ohio. Any other psychiatrist who sees patients less than 18 years old is really an adult psychiatrist practicing pediatric psychiatry. Ask the insurance company for a "Board-certified Child & Adolescent Psychiatrist). Amazingly, many health insurance companies won't tell you there is a difference, or they expect a child to be seen by an adult provider (this would be like requiring your child with a physical health problem to be seen by an adult intermal medicine doctor instead of a pediatrician). The mental health of children is significantly different from adults (diagnoses vary, they look different, medications respond differently (some adult psychiatric medications can make a child suicidal or just don't work). Most importantly the adult psychiatrist is not able to take into account normal childhood development in assessing the child so they have a hard time teling what is normal and what is abnormal. Your health insurance contract assures appropriate care for your family, not just care; otherwise psychiatrists could be doing surgery!
  • Ask your insurer if they can suggest a "Board-certified" child and adolescent psychiatrist (someone who has done a fellowship in this area not a 1 or 2 month rotation) who is within a reasonable distance of your home. Often they will give you names, but they are adult not child & adolescent psychiatrists. If they assure you this is a properly trained physician, call that provider to make sure s/he is taking patients within a reasonable amount of time (usually defined as one month except in emergencies). Because of the shortage of child & adolescent psychiatrists, most providers have a long wait. Again, your child is entitled to reasonably prompt care.
  • If the insurer is willing to make a single case agreement, find out the steps that company requires and begin this process. At some point you will need to call our office to make certain the terms are acceptable to us. Make sure you have done this BEFORE the first visit. Most insurers will not consider a single case agreement after this first visit.
  • If you believe the insurer is being unreasonable, then lodge a complaint with the a supervisor at the insurance company and demand an appropriate referral. You can also ask your employer (or their Human Resources Department) to lodge such a complaint with the insurance company. Often company requests are given more weight since they are the biggest customer for an insurance plan. As a last resort, you can also make a complaint with the State of Ohio's Department of Insurance (click the preceeding title to be redirected to that site). Unfortunately, as you are aware, health insurance is very complicated.

Feel free to call our office for questions about handling payment and insurance questions.