Any questions regarding patient accounts, insurance benefit issues, or billing should be sent to:
[email protected]
Fees:
Fees for mental health services can be complex and confusing, and clients are entitled to fair and clearly-stated fees for services. I set my fees to be consistent with prevailing rates for the area, and with allowable rates for services provided through health insurance. Therefore, I am able to bill at my usual and customary rates, rather than artificially high standard rates; and I adjust the balance owed when claims are processed, to reflect the current allowable rates. This also means that I do not “balance bill,” or charge the patient the difference between the usual/ customary and allowable rates. Instead, I write off this difference. Most preferred provider organizations require providers to do this.
Dr. Fitzgerald’s usual and customary fee (as a licensed psychologist) for an initial mental health assessment session is $185.00. A 45 minute therapy session is $125.00, a 60 minute therapy session is $155.00, and a family or couples’ therapy session is $132.00.
The common procedure codes for psychotherapy changed in 2013 so that the traditional 50 minute session was re-defined as 45 minutes. That means that if our sessions last between 38 and 53 minutes, they are to be billed as 45 minute sessions; and if they last between 53 and 60 minutes, they are to be billed as 60 minute sessions, consistent with the guidance provided by the American Psychological Association.
Insurance and Managed Care Networks for Dr. Fitzgerald:
The client’s only responsibility under PPO and managed care plans is for the deductible and co-payment (a fixed amount) or coinsurance (a percentage). These vary by health plan and are either listed as “Specialist” co-payments on your insurance card, or are the same as standard doctor’s office visits.
In-Network for the following insurance networks:
- Aetna
- Blue Cross/Blue Shield PPO (including Blue Choice/Blue Choice Options))
- Cigna
- Humana Behavioral Health (LifeSynch)
- Medicare Part B
- Multiplan/PHCS (Private Health Care Systems) PPO, and PHCS Savility
- United Behavioral Health (UBH/Optum network)
- I am also In-Network for out-of-state Blue Cross-Blue Shield PPO plans such as Anthem, through reciprocal network participation.
I am no longer on the panels of Beacon Health Options (formerly Value Options) or Magellan Health.
I am out of network for BCBS HMO Illinois and Blue Advantage HMO, which exclusively use behavioral health providers affiliated with the physician group you have selected. You must obtain a referral to one of those providers from your primary physician.
I am also out of network at this time for Aetna Better Health/Medicaid plans purchased on the Illinois exchange. Please contact a local group that participates in this plan, such as Associates in Behavioral Science in Berwyn.
In-Network for the following Employee Assistance Programs:
- American Behavioral
- Cigna EAP
- Humana LifeSynch EAP (includes the former Harris Rothenberg International)
- United Behavioral Health (Optum) EAP
- Ceridian LifeWorks
- E4Health (includes the former Wellness Corporation, Sobel & Raciti, and People Resource EAP/Student Resource Programs)
- New Directions EAP (Includes US Postal Service EAP)
- Perspectives
- Employee Resource Center (Green Bay)
I am no longer in-network with Beacon Health Options (Value Options) EAP, Military OneSource, or Magellan EAP.
In general, you must obtain a referral from the EAP call center before setting up an appointment with me, in order for services to be authorized. You may choose to use insurance instead, in most cases. However, some health plans require you to call the EAP first in order to have any outpatient mental health or substance abuse services covered. The EAP serves as the behavioral health “gatekeeper” for these plans.
Medicare: Dr. Fitzgerald is now (effective 5/28/2015) approved for Medicare as a Part B provider.
Medicaid: I may be a provider ONLY for Blue Cross/Blue Shield managed Medicaid BCBS Community Plan).
I am not a Medicaid provider for standard medical assistance cards (Illinois Dept. of Human Services). The managed Medicaid market in Illinois is constantly changing as the provisions of the Affordable Care Act and Illinois’ Medicaid privatization efforts are met with new products resulting from arrangements between the state and insurance companies. Some (like Blue Cross/Blue Shield) will use the existing PPO networks, but most others (like Aetna Better Health) are setting up smaller networks, which are more often based out of hospitals and physician groups, and operate more like an HMO using within-group referrals. I am not a provider with any of those plans. I am also not a provider for CountyCare, which is the Cook County Medicaid plan.
For these plans (including Meridian, Molina, and Aetna Better Health) I recommend Clearwater Counseling Center in Chicago. They can be reached at (312) 880-9913. Their website is www.clearwatercounselingchicago.com. You can also inquire with Pillars Community Services in the western suburbs, though they often have a waiting list.
Obamacare Exchanges: Health care plans bought through the exchanges (“Obamacare”) are also changing every year, and finding a provider can be quite confusing right now. I will do my best to find out if I am a covered provider. If you bought insurance through an exchange, you should check with your plan first to find out which behavioral health providers in your area are listed as participating behavioral health providers, before calling anyone. Again, the only one in which I am fairly sure I am included is Blue Cross / Blue Shield.
Other Professional Services:
Psychological testing is billed at a per-hour rate, and includes only face-to-face time (not including scoring or report-writing time). Brief inventories for depression or anxiety, as well as Adlerian Life Style assessments, are generally conducted within a regular 60 minute therapy session, as they constitute part of treatment. Substance abuse assessments may be covered as EAP sessions, may be regular mental health assessments, or may be considered psychological assessments, depending on the reason for the referral. DOT (SAP) substance abuse assessments are a separate process with their own billing. See the “DOT SAP Evaluations” tab for more information.
I may be able to provide some services at a reduced fee, for those who have no insurance or who choose not to use health insurance (for reasons of privacy or to avoid session and coverage restrictions). I will be happy to discuss these arrangements prior to the beginning of services.
EAP Services:
Some employers, unions, or benefit plans provide a limited number of counseling sessions (between 1-12 sessions, typically 3-8) at no cost to employees or family members. If sessions are authorized in this manner using your Employee Assistance Program (EAP) benefit, you are not responsible for any payment. Call your EAP’s toll-free number to arrange services. Some “formal” (job performance) EAP referrals are made through the employer, when there has been a workplace issue or policy violation. For these formal referrals, the employee still does not pay for clinical services. However, the employee will be expected to give written consent for a report of attendance and compliance to be provided to the employer. It is very important for you to obtain the following information and provide it to my office prior to the first EAP session:
- The name of the organization or vendor providing the EAP program (for example, Ceridian LifeWorks, Aetna, Cigna, or Optum)
- The start and end dates of the EAP service authorization
- How many sessions are authorized
- The authorization number
- The toll-free number that you called to obtain the referral and authorization
- A copy of the authorization letter or e-mail message authorizing services.
Please note that any sessions that fall outside of the number or date range of authorized EAP sessions will be your responsibility, unless paid through your regular insurance. For example, if you obtain authorization that does not start until the day after your first session, you may be responsible for payment for that first session.
Claims and Payment
I will submit claims to your insurance company, and ask that you assign benefits to Fitzgerald Counseling when you provide the initial consent for services. I will provide statements of your account at your request, for flexible health spending account or tax purposes. NOTE: If your health spending account is tied to a debit card, you may be able to use it for in-office payments of portions of the charges not covered by insurance. Occasionally, the practice is not recognized as a health care expense by the credit card processor, and you would need to pay using other methods and then submit the charges to your health spending account.
I ask that any client payment amounts (including co payments and coinsurance) be paid at the time of the session. This includes amounts that are applied toward the deductible by the insurance plan, as well as agreed-upon sliding scale fees. Please do not allow unpaid balances to accumulate. We will send statements for amounts due and past due, and may send seriously overdue balances to collections.
Please note that any checks that are returned for insufficient funds may result in your being charged for penalties and fees imposed by the bank, in addition to the fee itself. Any check returned for insufficient funds will result in all of your fees and co-payments being payable in cash only from that point forward.
Payment methods accepted at time of counseling / psychotherapy sessions:
- Cash
- Personal Check
- Credit Cards (Visa, MasterCard, Discover, American Express)
- Flexible Health Spending Account cards (Visa or MasterCard)
Credit card payments at the time of therapy sessions are accepted by means of the Square system (www.squareup.com) and are as secure as industry standards require. Credit card information is encrypted in the card reader prior to transmission. Square prohibits the storage of card numbers, magnetic stripe data, and security codes on client devices.
I am now accepting payments via chip-enabled credit and debit cards via the Square chip card reader. These cards (which are being sent out to cardholders during 2015) are more secure than the older magnetic stripe cards, as they generate a unique token for each transaction. When meeting with you in the office, I use the Square chip and contactless reader, which will enable the use of Apple Pay and other contactless payment methods using cards and smartphones. These payment methods are also heavily encrypted and much more secure than traditional magnetic stripe cards. For more information on security please visit the Square website. For more information about EMV (chip) and NFC (contactless) payments via Square, please see their page on the topic.
Square asks for your signature for transactions over $25.00. It also offers you the option to receive a receipt by text message or e-mail. Be aware that these communications are generally regarded as not being HIPAA compliant health communications, but only include the type of payment (co-payment, etc.), the amount, and the name of the payee (Fitzgerald Counseling). The personally identifiable information included in this is roughly equivalent to what would be exposed if you wrote a check. If you have concerns about this from a privacy standpoint, you can ask me for a paper receipt or pay cash.
Payments may also be made via credit card or PayPal account using the button below. Please send me a message if making a payment for a previous session.
Please note that the $500.00 fee for DOT Mandated SAP evaluations must be paid online by PayPal or in person by cash, money order, or cashier’s check. At this time, I am not accepting personal checks or swiped credit/debit card payments for SAP evaluations. Payments for SAP evaluations may be made at the link below, www.paypal.me/fitzgeraldcounseling.
EXISTING CLIENTS: TO MAKE A PAYMENT…
If you are a current client and wish to make a payment or co-payment for session(s) that have already taken place, you may use the new “PayPal.Me” feature to make a payment, or use the PayPal button below. Please also send an e-mail message at [email protected], to let us know of your payment and if possible the date(s) of service to which the payment is to be applied. Thank you! We appreciate your use of our services.
Direct Payment Link:
www.paypal.me/fitzgeraldcounseling
Note: By using this PayPal link or button, you will be taken to the PayPal secure website, where you can use an existing PayPal account to make a payment, or you can create a new account using a credit card. Fitzgerald Counseling will not store any of your credit card information. If you have PayPal set up to e-mail you confirmation of a payment, you understand and accept that these e-mails are not guaranteed to be confidential, nor are they HIPAA protected.
“No Surprises Act” Information:
(Updated 2022)
The federal “No Surprises Act” which passed in December 2020 helps ensure that billing for health care services is as transparent as possible. I have always tried to operate my practice as simply and transparently as possible. What follows is a general model for my “Good Faith Estimate” of costs for those who are not using a PPO or in-network insurance plan, and are paying for services out of pocket. PPO and In-network services are reimbursed by the insurance plan according to their determination of medical necessity, and you must pay your share of covered in-network services (Providers are not allowed to waive or lower co-payments or deductible amounts). You may have a health spending account or flexible spending account that can be used for those amounts.
(Employee Assistance Services are always provided at no cost to the employee or family member, so there is no need for a good faith estimate of costs for EAP services).
Dr. Fitzgerald is not permitted to bill patients for adjustments or “take back” amounts from insurance companies, and will never attempt to bill a patient for any amount that exceeds the annual deductibles, out-of pocket limits, and co-payments (or coinsurance amounts) specified by the member’s plan for covered services.
The rates quoted below are my usual and customary fees for self-payment or out-of-network services, and may be adjusted downward if we agree at the beginning of treatment due to your financial circumstances or other special situation. The usual and customary rates listed below are not higher than the rates allowed by the larger insurance plans to which Dr. Fitzgerald belongs. This is intended to minimize or eliminate the adverse impact of out-of-network bills. In other words, fees are not inflated for self-pay or out-of-network services.
I will send a completed copy of this form to you if you request self-pay or out-of-network services. Some insurance plans pay a portion of the cost of out-of-network services. Dr. Fitzgerald will not charge more than the usual and customary fee minus the amount paid by insurance.
Fitzgerald Counseling Good Faith Estimate Form:
Date of Good Faith Estimate: ___/____/___
This estimate is for psychotherapy services through [Date] ___/___/____
Brief explanation of estimate for new patients:
The estimate below is the cost that is likely for most new patients. Until I do an initial evaluation and we start to work together, I will not have a clear picture of your specific diagnosis, issues and needs. I typically see therapy patients for 10-20 outpatient psychotherapy sessions for a total cost of $1435.00 to $2560.00. But in some cases a patient’s issues may be more complicated, so we may need additional sessions during the time covered by this estimate. You may also elect to continue therapy for personal growth, and are entitled to know what that is likely to cost per session going forward. Bear in mind that therapy is a voluntary process, and you may discontinue at any time without financial penalty and will only be responsible for the cost of the services already provided.
Brief explanation for continuing patients: The estimate below is the cost that I think is likely for your care over the time period covered by this estimate. However, depending on how treatment progresses, more or fewer sessions may be needed.
Contact: If you have questions about this estimate, please contact Dr. Fitzgerald at (708) 337-6936 or [email protected].
Details of the Estimate
The following is a detailed list of expected charges for psychological services scheduled for [date] ____/____/____ through [date] ____/____/____. The estimated costs are valid for 12 months from the date of this Good Faith Estimate, unless I send you an updated estimate.
|
Service |
Diagnosis Code (once determined) | Service code | Quantity
(# of sessions or range) |
Cost per unit | Expected cost |
| Initial evaluation 60 min. | 90791 | $185 |
$ |
||
| Psychotherapy | 90837 (60 min)
90834 (45-50 min) |
$155
$125 |
$ | ||
| Family or Couples Therapy | 90847 (45-50 min) | $132 | $ | ||
| Psychological Testing | 96136, 96130, or 96416 (per 30 or 60 minute unit) | $85 | $ |
Total estimated cost: $________________
NPI number: 104949585 TIN: 27-2560315
Address of office from which services will be provided:
____ 15 Spinning Wheel Rd. Ste 422, HInsdale, IL 60521
____ Tele-Health
Patient information:
Patient name _______________________________________ DOB ___________________
Disclaimer
This Good Faith Estimate shows the costs of services that are reasonably expected for the expected services to address your mental health care needs. The estimate is based on the information known to me when I did the estimate.
The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.
If you are billed for more than this Good Faith Estimate, and we are not able to reach a satisfactory understanding by discussing the amount and services, you have the right to dispute the bill.
You may contact Paul J. Fitzgerald, PsyD at the contact listed above to let the provider know that the billed charges are higher than the Good Faith Estimate and that you wish to dispute them. You can ask Dr. Fitzgerald to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.
You may also start a formal dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.
There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount.
To learn more and get a form to start the process, go to:
www.cms.gov/nosurprises or call CMS at 1-800-985-3059.
For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call CMS at 1-800-985-3059 .
This Good Faith Estimate is not a contract. It does not obligate you to accept the services listed above.
Keep a copy of this Good Faith Estimate in a safe place or take pictures of it. You may need it if you are billed more than $400 than the estimate provided above.
Using Health Insurance and Financial Information for Clients by Fitzgerald Counseling is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.