I do not accept any insurance or insurance payments, nor am I on any insurance panels.  If you are seeking out-of network coverage for payment to me, I will fill out insurance forms at your request and explicit direction.  When you are seeking such out-of-network coverage, please coordinate all communications with insurance companies. I am not a Medicare or Medicaid provider.

 

Payment of the bill is independent of and not contingent on reimbursement from insurance.    Payment is appreciated at the time of the visit or on receipt of bill, though weekly clients will be billed at the end of each month.  In addition to invoices in the form of a CMS 1500 form, which can be submitted to insurance for out of network reimbursement, a monthly statement will be sent if there is a balance at the end of the month.  In the event that you are temporarily unable to pay your bill, please discuss it with me, and I will set up a payment schedule with you. Accounts overdue for more than 60 days will be charged a monthly late fee of 5% of the total balance overdue.  In some cases, sessions will need to be temporarily stopped, except in an emergency, until payment is received.  In addition, accounts overdue by more than 90 days may be turned over to a collection agency. 

Fees:  

  

o  Psychiatric Evaluation (scheduled as one 120 minute appt or two 60 minute appts): $950

  • Additional sessions are sometimes necessary for an evaluation and will be billed at the rates listed below

o  Psychopharmacology/medication management

  • $425 for 30 minutes

  • $450 for 45 minutes

  • $475 for 60 minutes and hourly thereafter

o Psychotherapy

  • $425 for 45 minutes

  • $475 for 60 minutes and hourly thereafter.


In some cases discussed ahead of time, psychopharmacology appointments can be made for 15 minutes for $200; if the session runs over 15 minutes, the above fees will be charged
 

In cases where fees have been negotiated to a lower than full rate, fees will be increased approximately 5% beginning 1/1/2019.

Notes on the CMS 1500 insurance reimbursement form:

  1. In most cases, I have only completed my portion of the form; make sure every item in the form is completed with your information for your portion.

  2. Sign items 12; leave item 13 blank

  3. Diagnostic codes are listed under 21 (A-L); it is then “coded” in 24 E (as, for example, “A” or “AB”). Despite the CMS form explicating how I am to complete the form, insurance will often inaccurately claim I did not list the diagnosis.

  4. Complete item 29 if not already complete.

  5. Make a copy of your completed form and keep it for your records.

  6. You do not need to return the bill/insurance form to me with your payment; make sure to send the form to insurance if you are seeking reimbursement.

  7. Make sure your insurance company knows to send reimbursement directly to you and not to me; I must return and insurance payments sent to me back to your insurance

mark@markwwilsonmdpc.com

assistant@markwwilsonmdpc.com

(917) 441-2344

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