Dr. Marcus and the therapists at Brain Mind Harmony are not a participants or network providers for many insurance plans. Initially the patient pay the office directly at the time of service by cash, or credit card (credit card charge includes a 3% bank service charge). We will provide patients with a statement showing what has been paid, and all the appropriate codes which patients themselves can send to their insurance company to get reimbursement according to the benefits of their plan. After the initial evaluation, and if you will need frequent visits, we can explore your plan out of network options and adjust your out of pocket payments while we bill the insurance and collect the out of network payments. If you have an HMO and don’t have any out of network benefits, we can arrange for a single case agreement with your plan (if you qualify) subject to your diagnosis and treatment plan.
Some insurances require pre-authorization for a certain number of visits pre-approved in advance. It is the patient’s responsibility to know if this is necessary and inform us. We will fill out the appropriate authorization forms. We will not be responsible for a patient’s failure to inform us of the steps they require to have sessions pre- authorized by the insurance.
Brain Mind Harmony have “opted-out” of Medicare. This means that, although we can see Medicare patients, they will NOT receive ANY REIMBURSEMENT from Medicare for our services. If you have another insurance policy that is secondary to Medicare, it would be considered primary in the case of our services, because we have opted-out of Medicare. You should be able to file for reimbursement from this other insurance as if it were your primary. You would need to attach a note when you submit, to clarify that this other insurance is primary for our services because of we have opted-out of Medicare.
How to Obtain Insurance Reimbursement
To obtain some reimbursement from your insurance follow these steps:
1. We will provide you with a written statement after each visit to show what you ALREADY paid at the time of each visit, with all the appropriate codes.
2. This statement can be sent to your insurance company for reimbursement directly to you (though typically not for the full amount). You simply need to fill out your own insurance form, attach the statement we provide you with , and send these to your insurance company.
3. Specify on your form for that your insurance should pay you, not the doctor. If there is no place to specify paying you rather than the doctor on your form, then write the following (in red), somewhere on your insurance form: PAY SUBSCRIBER, NOT PROVIDER!
4. In the event that your insurance company sends me a check, despite your efforts to follow the above directions, when appropriate, I will sign it over to you, since you will have already paid me, otherwise, I will send the check back to the insurance with a not to send you the payment.
Learn more about our policies at Brain Mind Harmony >> Policies