Insurance Claim Filing
I am contracted with CIGNA insurance, so CIGNA patients are only responsible for deductibles and co-pays.
For all others, I will file your insurance claim for you (provided your insurance company accepts electronic claims – almost all of them do) and “balance bill” you for the portion that remains unpaid. Texas law requires insurance companies to process claims within 30 days, so any unpaid balance after 30 days becomes the patient’s responsibility.
I am “opted out” of Medicare – Medicare will not reimburse any fees and you will not be able to file a claim.
Psychotherapy a la carte
Maybe you’re not sure if therapy is right for you, or your schedule doesn’t won’t allow for weekly sessions, or you’d like to stick with only what CIGNA covers. You can choose to schedule each session individually, when your schedule permits. I can’t guarantee availability in any given week, but you can book out up to 1 -2 month’s appointments on a rolling basis if you like.
Weekly Standing Concierge Appointments ($300 per week)
Psychotherapy works best when it is consistent and regular. The weekly fee includes:
- One 40-50 minute psychotherapy session at the same time each week during regular business hours
- Prescribing of all medically necessary psychiatric medications
- Coordination with your primary care physician for all medical conditions, lab studies, or other testing
- Anytime online scheduling to view, cancel or change your appointments
- Anytime online patient portal for messaging, lab results and documents
- If hospitalization is required, Dr. Grugle will coordinate the admission process and see the patient on a daily basis. (Travel and inpatient attending / consultation fees apply)
- If requested, we will handle claims for any insurance benefits you may be entitled to; any benefits we receive will be used to offset your concierge fee
There is no charge for weeks that Dr. Grugle is not in the office or in case of winter weather (if Dallas or your local Public Schools are closed.)
Your progress in treatment may be enhanced by attending up to 4 sessions per week, which may be reserved in the same week on a recurring basis.
Non medically necessary services requested by the patient are not covered by insurance and are charged at a standard fee of $400 per hour (minimum $45). Examples of non-medically necessary services are completion of disability forms, FMLA forms, prescription pre-authorization appeals, completion of life insurance applications and duplication of medical records.
Policy regarding patient insurance change: When a current patient loses access to a health insurance plan which Dr. Grugle accepted, due to loss of eligibility, change of insurance plan, or doctor leaving the plan, upon request, Dr. Grugle will not balance bill the patient greater than (1) the allowed amount of the previous insurance plan or (2) the amount reimbursed by the insurance company plus the patient’s previous copayment amount, whichever is greater. Applicable only to patients with incomes at or below 800% of the federal poverty level and for a period not to exceed 12 months.
A current patient is one seen within the previous 24 months.
PATIENT SELF SCHEDULED A LA CARTE APPOINTMENTS:
Your appointment time is reserved for you and you alone. The full office visit fee will be assessed for broken appointments or appointments canceled with less than 24 hours advance notice, unless the cancelled appointment can be filled with another patient’s visit. Cancellation fees are not usually covered by insurance. In case of winter weather, cancellation fees will not be charged if Dallas, Richardson or the patient’s Public Schools are closed.
WEEKLY STANDING APPOINTMENTS:
Concierge fees are non-refundable (no refunds for cancellations, though every effort will be made to reschedule during the same week). There is no charge for weeks that Dr. Grugle is not in the office or in case of winter weather (if Dallas or your local Public Schools are closed.)
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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