What is the difference between a Psychiatrist, a Psychologist and a Licensed Mental Health Counselor?

A psychiatrist is a medical doctor who specializes in mental health disorders and can prescribe medications.  Psychiatrists mostly diagnose mental health disorders for the purpose of prescribing medications to help alleviate symptoms of the disorder.  Psychiatrists do not perform counseling. 

Psychologists have a PhD degree and are called doctors, but cannot prescribe medications.  Psychologists can perform counseling and also are known for providing psychological testing and assessments. 

Licensed Mental Health Counselors have a masters degree and perform counseling.  Licensed Mental Health Counselors do not prescribe medications.  Other types of Master level counselors include Licensed Clinical Social Workers and Licensed Marriage and Family Therapists.

 

Do you take my insurance?

I am an in-network provider for some insurance plans.  To determine whether you can see me using your insurance, call your insurance carrier and ask them if I am in your network.  See 'Tips for Checking Your Insurance Benefits' (section below) for more useful information.  Some insurance companies require pre-authorization before seeing a provider, so it's best to call ahead to avoid the chance your visits are not covered by your insurance.  If I am not in your insurance network, you may have an out-of-network benefit that may cover a portion of your visit.  Contacting your insurance company for the details of your coverage is the best way to find out.

*ATTENTION FLORIDA BLUE/BCBS CLIENTS

AS OF NOVEMBER 22, 2018 I WILL NO LONGER BE IN NETWORK

Here is a list of FAQ that may help…

What plans are effected?

All Florida Blue PPO and HMO plans, all Anthem plans, all out of state Blue Cross Blue Shield plans including federal BCBS.

Can I still see you as my provider?

Yes. You can continue to see me as an out of network provider.

How much will it cost?

Each session will cost $115 and will last one hour.

Can I still use my HSA or flex spending account for costs?

Yes.

Will insurance cover any of my visit?

It's possible you may have an out of network benefit to cover a portion of session cost. I will provide you with the necessary documentation to provide to the insurance company. Most PPO plans have an out of network benefit while HMO plans do not.

When will this change take place?

November 22, 2018. Until then all copay, co-insurance amounts and deductibles remain unchanged.

How do I find another in network provider?

There a several ways to find an in network provider if you wish to stay in your insurance network. You can contact the insurance company and request a list of names, you can go to the insurance company’s website and do a local search, you can also use psychologytoday.com (I recommend) to find a provider that specializes with your concern and even contact them through the website. I will make myself available as best I can to assist your choice.

Why are you leaving the network?

It has been a difficult decision to leave the network but following a sizable reduction (35%) in the rate of reimbursement last year I'm finding it difficult to sustain my practice while accommodating the cut. I have attempted to negotiate with the company to avoid leaving the network but was informed they are not negotiating with any providers. Many experienced providers have left the network for this reason. Compensation is not commensurate with experience.

What insurance do you accept?

If your insurance carrier changes in the future I am in network for Tricare, Cigna and Mayo Clinic Health Solutions.  

How much will it cost me?

If you are using your insurance benefits, you will likely pay a co-pay or co-insurance at each visit.  This amount depends on the type of coverage your policy provides.  You can find out this information (and I recommend doing so before a first time appointment) by contacting your insurance carrier. See 'Tips for Checking your Insurance Benefits' (section below) for more useful information.  For self-pay clients, my fee is $115 per session.

 

Tips for Checking Your Insurance Benefits

When contacting your insurance company, you’ll want to ask some specific questions.  First, on your insurance card there will be a customer service phone number.  It’s usually on the back of the card and will say “customer service” or “eligibility and benefits”.  Call the number and follow the instructions.  You will most likely be directed to member services.  You are trying to find out whether you are eligible to receive Outpatient Mental Health Services and if so, what your benefit is. More specifically, you will want to ask if you have a deductible, co-pay or co-insurance.

Deductible- a deductible is an amount that you have to pay before your insurance company will start paying.  It typically will renew every calendar year.  Your insurance company will tell you if you have a deductible and what amount remains to be paid.  You may have a co-pay or co-insurance after you meet your deductible.

Co-payment- this is a fixed amount that you pay every time you are seen for a counseling appointment.   

Co-insurance- this is a percentage of the amount that your insurance company pays for the service you are receiving.  For example, if you’re co-insurance is 10% and your insurance company pays $100 for that service, then you would pay $10 for each visit.

After you have found out what your benefit is, ask whether there is any pre-authorization required for Outpatient Mental Health Services and what the procedure is for getting authorization.  You may have to get authorization specifically to see me.  Clarify this with your insurance company.

 

Finally, ask whether I am a participating provider in your insurance network.  You may have to provide my location which is:

 

157 Hampton Point Drive, Suite 1

St Augustine, FL 32092