Insurance Policy
Drs. Kroll and Summers accept direct payment (i.e., "in-network") from Blue Cross Blue Shield PPO, Tricare, Medicare, the Veterans Healthcare Administration (Community Care), and CHAMP VA, Ms. Eastepp accepts direct payment from BCBS and Medicare, and Ms. Sieja accepts direct payment from Medicare. For in-network payors, you will be responsible for the copay amount (after any deductible) at the time of the service. Please remember at the beginning of each year or when you get a new plan, your deductible will be due before your insurance plan will cover any fees.
We are an out-of-network provider for other insurance companies, including most HMOs. This means that the full fee payment is due at each session, and you may receive reimbursement for all or a portion of this directly from your insurance company after you file your claim. A receipt detailing services rendered will be provided to assist you in filing. For some policies, these payments can be counted toward your deductible.
Insurance policies can be very confusing. Thanks to parity laws, mental health benefits should be covered by your insurance provider. However, your specific plan may include or exclude certain types of services. For example, your plan may only cover services for certain mental health diagnoses or may specify the number of sessions covered or the type of treatment provided. Some may require a referral from your primary care provider prior to being seen.
Ultimately, it is your responsibility to verify your insurance requirements.
To help you clarify your coverage, contact your insurance company and inquire about reimbursement for mental health services (sometimes called Behavioral Health services) provided by a Licensed Clinical Psychologist, a Licensed Clinical Social Worker or a Licensed Professional Counselor for the appropriate procedure (see codes below). Make sure to specify the type of provider you will see (Psychologist, Counselor or Social Worker/LCSW) as this will impact your reimbursement rate. It is important that you determine if your plan has specific requirements for out-of-network providers. For some plans, you may need to meet a deductible prior to coverage starting. In this case, the session fee will go toward meeting this deductible, and you will use the invoice provided to verify this to your company.
We are an out-of-network provider for other insurance companies, including most HMOs. This means that the full fee payment is due at each session, and you may receive reimbursement for all or a portion of this directly from your insurance company after you file your claim. A receipt detailing services rendered will be provided to assist you in filing. For some policies, these payments can be counted toward your deductible.
Insurance policies can be very confusing. Thanks to parity laws, mental health benefits should be covered by your insurance provider. However, your specific plan may include or exclude certain types of services. For example, your plan may only cover services for certain mental health diagnoses or may specify the number of sessions covered or the type of treatment provided. Some may require a referral from your primary care provider prior to being seen.
Ultimately, it is your responsibility to verify your insurance requirements.
To help you clarify your coverage, contact your insurance company and inquire about reimbursement for mental health services (sometimes called Behavioral Health services) provided by a Licensed Clinical Psychologist, a Licensed Clinical Social Worker or a Licensed Professional Counselor for the appropriate procedure (see codes below). Make sure to specify the type of provider you will see (Psychologist, Counselor or Social Worker/LCSW) as this will impact your reimbursement rate. It is important that you determine if your plan has specific requirements for out-of-network providers. For some plans, you may need to meet a deductible prior to coverage starting. In this case, the session fee will go toward meeting this deductible, and you will use the invoice provided to verify this to your company.
Tips for out of network claims
Call the number on the back of your card (there may be a separate number for "Behavioral Health") and ask for the procedure for filing for "out-of-network reimbursement," as well as the exact amount they will reimburse you for seeing a Clinical Psychologist or a Licensed Clinical Social Worker or a Licensed Professional Counselor (depending on which of our providers you are seeing) for the following procedural codes:
90791 (Intake)
90837 (Individual Session, 50 min)
90853 (Group Session)
96101 (Psychological Testing)
G0283 (Alpha-Stim session per 15 minutes)
If they ask for it, Dr. Kroll's National Provider ID number (NPI) is 1467638825, Terri Eastepp's NPI is 1659724698 and Lauren Sieja's NPI is 1629645155
Be sure to ask if you have a deductible that must be satisfied first. You may also want to ask if they can reimburse us directly so that you don't have to pay as much up front. If they are able to do this, have them fax the forms needed to (844) 269-6991 so they can be completed prior to your appointment.
90791 (Intake)
90837 (Individual Session, 50 min)
90853 (Group Session)
96101 (Psychological Testing)
G0283 (Alpha-Stim session per 15 minutes)
If they ask for it, Dr. Kroll's National Provider ID number (NPI) is 1467638825, Terri Eastepp's NPI is 1659724698 and Lauren Sieja's NPI is 1629645155
Be sure to ask if you have a deductible that must be satisfied first. You may also want to ask if they can reimburse us directly so that you don't have to pay as much up front. If they are able to do this, have them fax the forms needed to (844) 269-6991 so they can be completed prior to your appointment.
Good Faith Estimate for Cash Pay Patients
Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a “Good Faith Estimate” of expected charges.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
– You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
– Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
– If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
– Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
– You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
– Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
– If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
– Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises