I am an “out-of-network” provider and not contracted with insurance companies. This allows me to spend more time with my patients and ensures treatment decisions are made by patient and physician, not insurance companies. 

Fees are due in full at the time of service. On request, I will provide an invoice with the appropriate diagnostic information and services for patients seeking reimbursement from their insurance company except for Medicare as they do not allow reimbursement.

Many insurance policies provide out-of-network benefits that reimburse 70-80% of provider fees and sometimes 100% (fairhealthconsumer.org).

Here is a step-by-step guide to estimate your reimbursement rate:

1. Consult your health insurance brochure or:

2. Call your health insurance company, either before or after your first visit, and have the following conversation:

a) Tell the person with whom you are speaking that you are seeing an “out-of-network” psychiatrist.

b) Ask how much you will be reimbursed for CPT (Current Procedural Terminology) Code 90792 (psychiatrist initial evaluation) and follow up codes such as 99214 (psychiatrist follow up) or 90837 (psychotherapy follow up).

c) Ask how much your annual deductible will be

d) Ask how many certified visits you have per calendar year

3. Submit an invoice, see how much reimbursement you will receive, and read the enclosed E.O.B (Explanation of Benefits). Most health insurance companies are required by law to pay the claim or tell you why they are not going to pay within 30 days.

4. You should then have all the information you need to estimate the amount you can expect to be reimbursed for your treatment.

It is important to note that I am not in network with BadgerCare. As a result prescriptions for BadgerCare enrollees are not covered and not able to be filled by a pharmacy per Wisconsin state law. Therefore, I am unable to see BadgerCare enrollees.

Initial evaluation (90min): $450

Follow up appointment, medication focused (20min): $200

Psychotherapy +/- medication (45min): $250