Dr. Diez, Clinical Psychologist, Columbus Circle, New York City

 

 


Dr. Diez prefers not to be part of health insurance panels because:
  • they limit patient’s privacy and confidentiality,  
  • their goal is to manage (as in, "keep their costs down") your access to mental health services,
  •  they  require extensive paperwork and therefore increase the providers’ overhead costs and, most importantly,
  • they may hinder a mental health provider’s ability to practice in a tailored fashion by setting limited number of sessions, type of treatment offered, etc. ( for more on health insurance confidentiality and overall procedures)
Being out-of-network permits to offer a higher quality service to clients. However, as an out-of-network provider, Dr. Diez can facilitate health insurance reimbursement for you. Periodically (i.e., monthly) she will provide you a so called “Superbill”, containing the minimal necessary information about you and your treatment in order for you to obtain reimbursement from your insurance carrier.

You have insurance, and you’d like to use it for psychotherapy services with Dr. Diez. What to do?

The best thing for you to do as early as possible is to call the customer service number on the back of your card and ask the following questions:
  • Do I have benefits for outpatient mental health services?
  • What is my deductible and has it been met?
  • What is my co-payment?
  • How many sessions of outpatient psychotherapy does my plan cover per calendar year?
  • How much do you pay for an out of network provider?
  • Is there a limitation to how much you will pay per session?
  • Is a primary care physician referral required?
More Information on Mental Health Insurance Coverage

For a step-by-step guide to get all the right information from your insurance carrier, or to get preauthorization, click here
  • When your insurance is billed for payment, it will have access at least to your diagnosis and appointment dates through the invoices submitted. They may also require, from in-network providers, a treatment plan, type of  therapy being performed, clinical progress, etc.  The information they require from providers include a psychiatric diagnosis that will stay on database records and may be passed on to future insurers. Most insurance companies screen mental health benefit usage to determine if you are insurable (this includes disability and life insurance). When you pay out of pocket, the information is more in your control.
  • Many people chose to see a therapist without insurance paying for it (and therefore knowing about it) to prevent any possible disclosure of their health information.
  • Patients are usually covered for 12 to 30 sessions a year and are expected to pay 20 percent to 50 percent of the bill, depending on where you live and your therapist's credentials. For instance, Medicare ─ the federal health insurance program for Americans aged 65 and older ─ may cover 50 percent of most outpatient care, with no limit on number of visits.
  • Usually, there is a yearly deductible and a co-payment for each visit. Often, there is a yearly maximum on either the number of visits or the amount paid for psychiatric services, unless your plan or state has “parity" clauses or laws, which means that psychiatric treatment for problems with a biological cause (i.e., bipolar disorder, some depressions, some anxiety disorders  and some other illnesses) are covered as much as other medical illnesses.
  • In cases where there is no mental disorder serious enough to meet your particular insurance company’s guidelines, Dr. Diez will not issue a more serious diagnosis simply to secure better insurance benefits.
  • Many times insurance companies “carve-out” the mental health portion of their insurance, and thus if you have Medical coverage for one company you do not always have them for mental health coverage. For example, even though you may have a Blue Cross or Cigna health insurance card, you need to read the back of the card and check out your benefits to see if the mental health portion is “carved-out” to another insurance company. In addition, some insurance companies do not cover certain types of sessions (for instance: family therapy) and other insurance plans exclude certain diagnoses (for instance: autism) You may contact your insurance company.
Can you see a therapist of your choice with your current insurance?
  • If you have a Preferred Provider Organization (PPO) plan, you must again select from a limited number of providers, but it is possible to have fees partly covered for providers who are out of network. In this case  your out-of-pocket payments will likely be higher.
  • If you have a Point of Service (POS) plan ─also known as a “Fee for Service” plan─ you can see any doctor in the country, and your insurance company will cover your fees.
  • If you have a Health Maintenance Organization (HMO) plan or a prepaid health plan, you may choose from the health care professionals that they specify. These professionals are in-network providers, and it may not be possible to be reimbursed for the cost of out-of-network treatment.
*The information in this page information is intended to guide you in your choice of psychotherapist. This information may or may not apply to you or your insurance carrier. Dr. Diez cannot guarantee that your insurance will reimburse any costs incurred during your fee for service treatment with her.

The content on this website is for general information and educational purposes only, and is not intended to susbtitute professional services. Visiting this website or contacting Dr. Diez by e-mail or phone does not constitute or establish a therapeutic or professional relationshi
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Last updated on May 2014 | New York City