I am in network for these insurance companies:
- Tricare (standard provider, not Prime)
- Humana (no Medicare Advantage plans)
- Galaxy Health Network
- Scott and White
I am not accepting patients with UnitedHealth, Optum, or ValueOptions/BeaconHealth insurance plans as I have or will soon resign from those panels.
This is not a guarantee of coverage – please check with your insurance company to verify network participation status, deductibles and coinsurance. The health insurance market in the United States is very complex – failure to understand your insurance benefits and rights can cost you a lot.
Fair Health has many resources to help you understand how to best utilize your insurance benefits.
I will file your insurance claim directly with the contracted health insurance companies above and you will only be responsible for co-payments and deductibles. If I am out of network, I can provide you with a detailed invoice or a standard insurance claim form that you can use to file a claim with your insurance company. You’ll probably want to pay in full at the time of service to take advantage of the prompt pay discount.
Prompt Payment Discount
Upon request, a 25% discount may be applied to services that are paid in full at the time of service. This discount is available without regard to insurance coverage or benefit plan.
Statements are sent through the onpatient portal and are due upon receipt. If a paper statement must be mailed an additional statement fee of $25 per statement will be applied.
You may be billed for more than one charge per visit
Psychiatry is a mix of psychology and medicine. Several years ago, the federal government decided that we should bill each kind of service separately, and private insurance companies followed suit. When you come in for an office visit, you will probably see a charge for the medical part (prescriptions, labs, other medical stuff) and the psychology part (psychotherapy – the part where we talk about your problems.) Medications almost always work better when combined with psychotherapy, so almost all of my patients are treated with both.
The responsible party remains liable for all charges, whether or not they are covered by insurance. Please be sure you fully understand your insurance benefits and my financial policies before arriving for your first appointment.
Credit balances remaining on a patient’s account are refunded monthly, unless the responsible party requests otherwise.
Texas law requires insurance companies to pay claims within thirty days of filing. As such, it is my policy that the responsible party must pay the insurance portion of a claim if payment from the insurance company has not been received within 60 days.
Patients with overdue balances will only be seen for emergencies.
Collecting overdue accounts is a significant drain on time and resources. As such, a credit or debit card authorization must be placed on file for payment for the portion of services that insurance doesn’t cover, but for which the patient is liable. In the absence of this authorization, a statement fee of $25 will be added to your account for any balances that we must attempt to collect through the mailing of a monthly statement. In addition, an “outstanding balance” charge of 1.5 percent of the total bill will be charged for each month that the bill remains unpaid.
Your credit card information is kept confidential and secure and payments to your card are processed only after the claim has been filed and processed by your insurer, and the insurance portion of the claim has paid and posted to the account.
Non medically necessary services requested by the patient are not covered by insurance and are charged at a standard fee of $300 per hour (minimum $25). Medically necessary services are health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. Examples of non-medically necessary services are completion of disability forms, FMLA forms, prescription pre-authorizations, completion of life insurance applications and duplication of medical records.
Your appointment time is reserved for you and you alone. Broken appointments or appointments canceled with less than 48 hours advance notice will be billed to the patient at $100.00, unless the time is filled by another patient. In case of winter weather, cancellation fees will not be charged if Dallas or your local Public Schools are closed.
Insurance companies generally do not reimburse cancellation fees.
Patients may request a written estimate of their out-of-pocket expenses. Charges may vary based on the patient’s condition. The request may delay the scheduling of your care. The actual charges may differ from the amount paid by the third-party payer. The patient is personally liable for the services not paid by health insurance.
Dr. Grugle will not furnish adverse information to consumer reporting agencies regarding amounts owed by the patient if the patient finalizes a payment plan agreement within 45 days of receiving the first statement. You may be able to reduce some of your out-of-pocket costs for an out-of-network medical or health care claim that is eligible for mediation by contacting the Texas Department of Insurance at http://www.tdi.texas.gov/consumer/cpmmediation.html and 1-800-252-3439.
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