Insurance reimbursement

My practice is out-of-network with all insurances and full fees are due directly to my practice on the day of the visit. I'm happy to support you in navigating out-of-network reimbursement from your insurance plan in one of the following ways:

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1. Out-of-network reimbursement
   If you have a PPO, your insurance may reimburse you 60-80% of appointment fees. I can help look up your out-of-network reimbursement rate if you schedule a phone call with me and include your insurance provider and member ID. Unfortunately, I cannot look up "allowable amounts," which are maximums each insurance plan may place on what you are allowed to be reimbursed per CPT code. There is a prompt of questions below you can ask your insurance- with those answers, I can better help you understand what reimbursement might look like. Guide to out-of-network benefits (unaffiliated blog link)
   
   My practice offers courtesy billing via Reimbursify, which means that your superbills and paid claims will be automatically submitted to your insurance for reimbursement after visits. You don't need to submit superbills on your own (though you're welcome to if that's your preference!)
   
   Here are some questions you can ask to your insurance to understand what out-of-network benefits you have available: 
   
   "What is my out-of-network deductible, has it been met, and when does it renew?"
   "What percent will my insurance cover for out-of-network mental health care after I meet that deductible?"
   "Does my plan have maximum allowable amounts or usual customary rates?"
   "If so, what are the allowable amounts for the following CPT codes: 99205, 99214, 90833, 90836"
   "What is my out-of-network annual out-of-pocket maximum?"
   "Is approval or authorization required? If so, what's the process for that?"
   "Are my benefits on a calendar year basis, or a plan year? If on a plan year, when does it start?"
    

2. Network gap exception
   An insurance plan often has gaps in its coverage (i.e. not enough subspecialty physicians to cover the needs of its subscribers). This is particularly true in psychiatry. Insurance companies can approve a network gap exception to prevent the delay of essential care. This exception allows the patient to receive care from an out-of-network psychiatrist while only paying in-network costs.​
   
   You can call your insurance to request this or message your insurance with the following prompt:​
   
   I'd like to request a network gap exception to work with an out-of-network psychiatrist Tiffany Hwang, MD. Can you help send me the necessary forms and begin any prior authorization process necessary? If this network gap exception is approved, will my appointments with this doctor be covered at in-network rates?
   
   Provider name: Tiffany Hwang​
   Tax ID#: 87-4491431
   NPI: 1093246712
   Address: 825 Oak Grove Ave Ste D202, Menlo Park, CA 94025
   Phone number: 650-713-2288
   Fax: 701-291-7368
   Place of service: 10
   Approx date of service/approx date range: Start date + 1 year range
   CPT & Diagnosis code to request monthly medication management coverage: 99205 (1 count), 90836 (1 count), 99214 (12 count) and 90833 (12 count). *Will be different for weekly therapy*
   Clinical reason: I'm unable to find an in-network psychiatrist with immediate availability and appointment regularity who has the expertise to work with patients taking psychotropic medications in [pregnancy/breastfeeding/perimenopause/applicable reason]

 

​If your insurance has this option available, they will send you a form. Submit this form at the following link and book a phone call to discuss with me: Network gap exception form upload

 

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With both of these reimbursement methods, you are still responsible for the full appointment fee on the day of the appointment to my practice directly. While my practice helps to submit the claims for you, you are responsible for understanding what your out-of-network coverage and personal responsibility will be. 

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I do not participate in single case agreements.​​