SERVICE FEES

Therapy Session Fees

Treatment sessions are structured to be between 45-50 minutes in length, and are billed at $110 per session. However, many clients have insurance plans with whom I have a different contracted rate. Under these circumstances, clients are only liable for specified deductibles and co-payments as outlined in those plans. My practice policy is for clients to pay their portion of fees at the time of their appointments.

Self-Pay Option

If you do not have health insurance, or choose not to use it (see Utilizing Insurance section), then I will discuss a self-pay fee option with you. This is a rate often adjusted to reflect your financial circumstances and the services you are requiring.

Other Services

There are certain services that I may be called upon to provide that will be charged at different rates (e.g., court appearances, depositions, school meetings, report preparations). These services are not ordinarily reimbursed by insurance plans, and these costs will be discussed and agreed to prior to the services being provided.

Missed Appointments and Late Cancellations

My fee for missed appointments and cancellations with less than 24 hours notice is $70. This is the least desirable fee to pay (and to collect). Nonetheless, this is a very important fee to be aware of and respect. It’s purpose is to prevent lost treatment time, not to punish for it. Appointment times lost in these ways would otherwise be available to clients on my waiting list. The 3 parties who lose under these circumstances are you, another client waiting for care, and myself.

In exchange for my clients respecting my policy about missed appointments and late cancellations, I will be respectful of special circumstances that might necessitate a missed appointment. If the weather or travel conditions present a serious risk or obstacle, or if there is a bono fide emergency situation, I will waive this fee. Also, if I can change your appointment time within the same week, or switch it with another client, I will attempt to do so without assessing this fee.

Collections Policy

Under the rare circumstance that a client generates an unpaid debt for my services, I reserve the right to utilize small claims court or a collection agency for collection purposes. I will not employ these measures without giving the client prior notification and opportunity to resolve their debt.

USING INSURANCE

Which Insurance Companies is Dr. Kandle Covered By?

The two principle insurers in the state of NH are Cigna Health Care and Anthem BC/BS. Each has a variety of insurance plans to choose from. Then there are many other plans offered from out-of-state companies, most of which will recognize me as a provider.


Cigna Health Care: I am able to accept all plans under Cigna Health Care. Steps you need to take are first to call me to schedule an appointment time, and then call the toll-free number on the back of your insurance card for mental health services. Tell the representative that you have an appointment to see Dr. Kandle, and you will then be given an authorization for your initial visits. Cigna will not pay for services that are not authorized, so this is an important step.

Anthem BC/BS: Anthem includes a variety of managed care plans: Matthew Thorton Blue, Blue Choice, and HMO Blue. I am not a provider under any of these plans. However, if you have a Blue Choice plan, this entitles you to see whatever provider you wish, regardless if they are in the provider network or not. To see me under a BlueChoice plan would require several things:

1) payment of a deductible
2) having a higher co-payment
3) paying my fee directly to me, then waiting for the insurer to reimburse you later
4) calling Blue Choice prior to treatment to receive an authorization.

The Anthem indemnity product or “point of service (POS)” plans will provide you with coverage to see me.

Other Plans: United Behavioral Health, Value Options, Health Care Value Management (HCVM), and Private Health Care Systems (PHCS) are several of the other networks I belong to. What confuses many people is that fact that insurance companies often have contracts with an outside party to manage their mental health benefits. For instance, an individual might be covered by an Aetna insurance policy, which might utilize a company like Magellan for mental health benefits.

What You Should Determine Regarding Your Insurance Benefits Prior to Treatment

1) Is Dr. Kandle a provider for my insurance company?
2) Do I need to have my treatment “pre-authorized?”
3) Do I have to pay a deductible, and what is it?
4) What is my co-payment?
5) What are the limits of my mental health plan in terms of number of sessions per year or dollar-amount limits?

All of these questions can be answered by calling the number on the back of your insurance card, or by consulting your benefits handbook.

What are the Implications of Using Insurance for Mental Health Care?

This is an important issue to understand. Any time you utilize your insurance for mental health care, certain basic pieces of information must be submitted to your insurance company. This includes; 1) who is in treatment, 2) the date of service, and 3) a diagnosis code. Indemnity plans, POS plans, and PPO plans usually only require this much information.

If your insurance plan is an HMO (managed care), then additional information is generally required for release to the insurance company. HMOs operate under the principles of limiting treatment to only what is truly “medically necessary.” In order to determine if your treatment meets the standards of medical necessity, they will periodically require me to submit a “request for authorization” or “treatment plan” form. These documents usually require the following types of additional information:

1) What are the symptoms being treated?
2) In what ways and to what extent do the symptoms impair the client’s functioning?
3) Is there a problem with substance abuse?
4) Is the client or anyone else in danger of physical harm or death?
5) Has the client’s physician or psychiatrist been consulted?
6) Is the client taking medication(s) for their condition, and if so, what are the names and dosages of these medicines,
7) What are the treatment goals for the client, and/or how long is treatment expected to last.

Now, if you’re thinking that providing this type of information is an intrusion of your privacy, you are correct. This is one of the most unfortunate characteristics of the managed care of mental health. However, your personal information can still be guarded extremely well within these requirements. Any concerns about specific information being shared can be discussed with me prior to any information being released to your insurer, and I place great emphasis on insuring my client’s privacy to their satisfaction.

What if I Don’t Want Any Information Released to My Insurance Company?

Self pay is the only way to guarantee that absolutely no information is shared with your insurer. One important implication of basic information being shared with your health insurer is that it could potentially affect how you might qualify of other insurance plans, such as life insurance. If there is a record of certain mental health diagnoses or medications being used, this could either disqualify you from certain insurance plans or increase your premium rates for an insurance plan.

If you wish to consider a self-pay arrangement, I will speak with you about this option, and often adjust my fee depending on your financial circumstances.