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Insurance:

We are currently accepting the following insurances in DC, Maryland, and Florida:

  • Aetna

  • Cigna

  • Optum/United Healthcare

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*Please note, there are some subsidiary plans under the above mentioned umbrella plans that we are not in-network with.  As there are literally thousands of different insurance plans, we cannot know for sure if we are in-network for you until we run your insurance eligibility.  Once we verify your eligibility, you will receive an email informing you of your ability (or lack thereof) to be seen in-network with our practice.  All patients are responsible for understanding their insurance coverage, to include co-pays, deductibles, and co-insurances.

 

We are Tricare Certified (not in-network, but appointments are eligible for reimbursement).  Please read the "Self-Pay and Out-of-Network" section of this page for information on using out-of-network benefits.

 

***We are not in-network with Medicaid or Medicare, even if they are contracted with one of the above insurers.

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Note:  Insurance claims are processed by Alma, and all patients using insurance will have a profile created in their system for this purpose.  We do require that patients keep a card on file with Alma for any co-pay or deductible that may be due.

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Self-Pay and Out-of-Network:

Out-Of-Network (OON) Patients (those that have insurance that we are not in-network with):

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For those who wish to receive care from The Fix OON, we are excited to announce that we are working with Reimbursify, a company that eases the reimbursement process for OON insurance claims. Reimbursify also allows us to check your OON coverage (to an extent-see more below), or you are able to do so yourself here, before you make the decision to work with us OON.  It’s important to note that not all plans include OON coverage, in which case you would not be reimbursed for your appointments with us.  If you decide to work with The Fix and utilize OON benefits, here’s what this process would look like:

 

  • Our practice (or you) can use Reimbursify to look up whether you have OON coverage, to include if an OON deductible applies

    • If you have OON coverage, Reimbursify will NOT show us what your plan’s allowed amount is, so you would need to contact them to determine this

    • When contacting them, they’ll want to know which CPT (billing) codes you’re inquiring about.  The most common codes are as follows:

      • Intake appointments:  99205

      • Follow-up appointments:  99213 (20-minute appointment), and 99214 (30-minute appointment)

    • OON coverage is usually presented as a co-insurance percentage (you would be reimbursed the difference), and you may or may not have a deductible to meet before that applies

      • If you have an OON deductible, you would not be reimbursed any amount until your deductible is met

      • Once the deductible is met, you would be reimbursed the difference of your co-insurance

        • Example #1 based on an allowed amount of $125 for a service with a 99214 code, and a 20% co-insurance (80% is reimbursed):

          • You pay our self-pay fee of $150 and submit the superbill for reimbursement

          • Insurance will reimburse you $100 (80% of the allowed $125)

          • Your out-of-pocket cost after reimbursement is $50

        • Example #2 based on an allowed amount of $200 for a service with 99214 ($150) + 90833 ($50) codes, and a 30% co-insurance (70% is reimbursed):

          • You pay our self-pay fee of $150 and submit the superbill for reimbursement

          • Insurance will reimburse you $140 (70% of the allowed $200)

          • Your out-of-pocket cost after reimbursement is $10

  • The self-pay fee is collected at the start of your appointment using the card we have on file for you

  • We provide you with a superbill, which is essentially a receipt that lists the services you received (to include the codes we mentioned above), and the amount you were billed

  • You submit the superbill to your insurance company through the Reimbursify app for free, or we can submit the claim for you for $5 per claim

  • Your insurance company reimburses you directly or applies the amount to any out-of-network deductible, if this applies

 

Self-pay fees are as follows, and apply to those using OON benefits, as well as those who are paying out-of-pocket with no expectation of reimbursement:

  • Initial Psychiatric Evaluation (60-90 minutes): $325

  • Follow-Up/Medication Management (30 minutes) $150

  • Follow-Up/Medication Management (20 minutes) $115

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