Fees, Billing, and Insurance



Fees


Dr. Falk’s current rate is $160 per hour, which is billed in 15 minute increments (for example, $120 will be billed for a session that lasts 45 minutes).  Group therapy fees vary by type of group, and psychological testing and evaluation fees vary based on the type of evaluation conducted.  Please feel free to discuss rates with Dr. Falk to avoid any confusion.


Billing


Billing will occur after each appointment, and payment is expected at that time.  Major credit cards are accepted.


Insurance and Out-of-Network Reimbursement


Dr. Falk does not participate with any insurance plans*. This policy has the advantage of preventing third party payers from imposing rigid treatment options and limitations on your care, as well as preventing third party payers from accessing information regarding the content of your sessions.  Services are conducted on a fee-for-service basis.


As a Licensed Clinical Psychologist, Dr. Falk’s services may be covered in full or in part by your health insurance or employee benefit plan.  This is between you and your insurance company.  Dr. Falk is considered an out-of-network provider.  You may be eligible for reimbursement if your insurance plan includes an out-of-network provider reimbursement option and you choose to make use of it.

 

Following payments for services, you will be provided with receipts that you can submit to your insurance carrier for any out-of-network reimbursement for which you are eligible.  Additionally, psychological services may be eligible for Flexible Spending Account (FSA) and Health Savings Account (HSA) reimbursement.

 

If you think you will want to make use of any out-of-network benefits provided by your insurance plan, you will want to check your coverage carefully to be certain of your terms and reimbursement rates.  Applicable procedure codes that are used most frequently include: 90791 (initial diagnostic evaluation); 90832 (16 to 37 minute therapy session); 90834 (38 to 52 minute therapy session); 90837 (> 53 minute session); 90853 (group therapy); and 900846 or 90847 for family and collateral therapy sessions.  Psychological evaluation procedure codes may vary.

 

Although you can submit your out-of-network claims for free to your insurance company, some people may prefer paying a small fee to a company called External link opens in new tab or windowReimbursify.  Reimbursify will submit your claims for you and make it easier to navigate insurance issues.  Dr. Falk has no financial relationship with this company and provides information about this option in hopes that some patients will find it helpful in simplifying the process of receiving their out-of-network reimbursements quickly.


Some questions to discuss with your insurance carrier if you decide to seek reimbursement for treatment services:


  • Do I have out-of-network mental health benefits?
  • What is my deductible and has it been met?
  • How many treatment sessions per year does my health insurance cover?
  • What is the coverage amount per session?
  • Is pre-authorization required from my primary care physician?
  • Within what time period must the claim be submitted to the insurance company?


*The sole exception is "straight" Medicare.