In order to maintain a smaller practice with a high level of attention to each patient, Dr. Mendelsohn does not currently participate in commercial insurance plan networks. She does accept the Columbia University Student Aetna plan and reserves space in her practice to see students and artists through insurance or at sliding-scale rates. Her practice will provide necessary documentation to obtain insurance reimbursement for out-of-network services.
Some information you may want to obtain from your health insurance to better understand the expected cost of out-of-network treatment is as follows.
Deductible: the amount you have to pay upfront before your insurance starts reimbursing you.
Allowed fee (also known as the reasonable and customary fee): the fee an insurance company deems is reasonable for a given medical billing (CPT) code, which is used to determine reimbursement rates. Some examples of common billing codes in psychiatry include 99204 (initial evaluation), 99213/90833 (30 minute follow up appointment), 99213/90836 (45 minute follow up appointment).
Coinsurance: the percent of the allowed fee you have to contribute per appointment after meeting the deductible. Your insurance will then reimburse you the remainder up to the allowed fee.
Out of pocket maximum: The maximum amount you can spend in a year on the deductible and coinsurance, after which the insurance will cover 100% of allowed fees.
You may also want to see if your employer offers a Health Flexible Spending Account (FSA), which you can use to cover out-of-pocket treatment expenses.
Alana Mendelsohn, MD PhD | New York City 