Billing

Neuropsychiatric Institute requires your current insurance information before scheduling appointments.  We contact your insurance company to receive a quote of the benefits for the plan you have chosen from your insurer.  We also run monthly eligibility checks to make sure coverage is still active.  We accept patients from most insurance plans, and each company sells many different plans.  We rely on the coverage information quoted by insurers, which we then relay to the patient in order for the patient to be able to make proper financial/treatment decisions, and for us to collect the proper payment each visit.

Fee for Service

If a patient does not have insurance, our staff can quote a "fee for service" or self pay amount for each visit.   Please call our office to be quoted current pricing for patients with no insurance.

Copayment vs Coinsurance and Deductibles

Copay-  is the amount you have to pay for each appointment.  A copay generally allows the patient to know what they are expected to pay, as it is usually the same amount at all doctors appointments.  A copayment must be paid for each doctor.  Therefore, if you have a medication management appointment and a separate therapy appointment, you will have to pay two copays.

Coinsurance- is the different than a copay, because it may differ from one appointment to another.  When your plan requires payment of a coinsurance, you pay a percentage of the doctor's fee.  This usually means that the first appointment will cost you more than subsequent follow up appointments.

Deductible - is the total amount that the patient must pay (each year) before the insurance company will pay any medical bills.  Generally, after the insurance company processes claims showing the patient has paid doctors the amount equal to the Deductible, the patient will be responsible for a Coinsurance amount.

Medicaid's Medically Needy (Share of Cost)

Individuals who are not eligible for "full" Medicaid because their income or assets are over the Medicaid program limits may qualify for the Medically Needy program. Individuals enrolled in Medically Needy must have a certain amount of medical bills each month before Medicaid can be approved. This is referred to as a "share of cost" and varies depending on the household's size and income. Individuals must pay doctors and pharmacies on an out-of-pocket basis and have the provider submit a claim as soon as possible, so it can be credited to the individual's monthly deductible (cost share).  Once an individual meets the share of cost for the month, Medicaid will pay doctor and prescription bills for the remainder of that month.  Information about this program can be found in the Medically Needy Brochure.

Insurance Claims and Patient Billing

We submit your claims to your insurance company.  Submitted claims are sent showing the amount we charge, along with the amount you have paid for a certain visit or series of visits.  Your insurer will process these claims in accordance with the benefits for your particular health plan.  The insurer will send our office an Explanation of Benefits which explains what your plan covers, including a breakdown of the amount the patient is responsible to pay, the amount the doctor was paid (if any) directly by the insurer, and any amounts that are not covered.  If the amount processed by your insurer differs from the amount we were initially quoted or the amount collected at the time of visit, then you will be asked for any balance due at your next appointment or will be billed by mail.

If you need help understanding the amount billed, you can contact our billing department with any questions.  If you disagree with the way your claim was processed, you should contact your insurance company with any questions and explanation of the benefits of your insurance plan.  If your insurer finds a mistake in the way they processed your claim, please call our billing department to let us know if they are automatically reprocessing the claim, so that we can remove the amount from patient billing and enter notes about expecting an additional payment from your insurer.