Insurance / Fees

Insurance and Fees

Insurance:
Beginning in May of 2010, The Bay Area Children’s Association will now submit claims for all of our clients, including patients who are out-of-network, in an effort to make the care process easier.  This means that you will no longer need to submit a “Superbill” to your insurance carrier.  We can do the submission electronically, which should speed the reimbursement process.  For patients who are out-of-network, you will still need to pay for the services up-front, but then either you will receive a check from your insurance company or they will send us payment from which we can give you a credit or reimburse you.  This should make the process of getting proper mental health care easier for our patients and families.

NEW! Handout on using out-of-network benefits. Be sure to check your health insurance coverage for outpatient out-of-network mental health care. Usually, there is a yearly deductible and a co-payment for each visit. Often, there is a yearly maximum on either the number of visits or the amount paid for psychiatric services, unless your plan has a parity clause. A parity clause means that psychiatric illnesses with a biological cause (most depressions, many anxiety disorders, bipolar disorder, and some other illnesses) are covered as long as medically necessary without a yearly maximum, just like other medical illnesses. For each appointment, you will receive a “Superbill”, which contains all of the necessary information to receive reimbursement from your insurance carrier.

As The Bay Area Children’s Association is adding new providers, the acceptance of insurance will vary.  Current insurance contracts are not always extended to new providers, which makes providing care more difficult.  Currently, the only insurance that is fully in-network for all providers at the Bay Area Children’s Association is Aetna.  Cigna, Blue Cross and Valley Health Plan may be in-network depending on the provider you see. Many times insurance companies “carve-out” the mental health portion of their insurance, and thus if you have medical coverage for one company you do not always have them for mental health coverage. For example, even though you may have a Blue Cross or Cigna health insurance card, you need to read the back of the card/check out your benefits to see if the mental health portion is “carved-out” to another insurance company. In addition, some insurance companies do not cover certain types of sessions (For example, Family Therapy) and other insurance plans exclude certain diagnoses (For Example, Autism) You may contact your insurance company and ask for an out-of-network contract or to initiate discussions to cover services rendered by the Bay Area Children’s Association. Payment for services can be via check, credit card, or online payments.

Fee Schedule:
Although there is flexibility in beginning treatment, initial evaluations usually consist of four sessions: In addition, a CPT code of 96101 is billed for preparation of the final report and scoring of questionnaires. This fee is $200.00

Thus, if you are not contracted with one of the accepted insurance agencies, the total fee for the evaluation sessions and report is $1100.00.

Visit Details Fees

Initial visit – 50 min with the caregivers. (CPT code 90846) $200.00
This includes giving age-appropriate mental health questionnaires to the parents. This is almost always the first session.

50 minute session with the child (CPT code 90801) $300.00
This session is usually to establish trust and rapport, and provide initial impressions.

50 minute session with the child (CPT code 90807) $200.00
This session provides more time to interact with the child and assist with making a diagnosis and treatment plan.

50 minute session with the caregivers(CPT code 90846/47) $200.00
If the child is above age 13, they are usually invited to this session as well. This is a wrap-up session where results of the questionnaires, diagnostic impressions and treatment recommendations are discussed. At this time, the family can decide to pursue treatment at the Bay Area Children’s Association or elsewhere. If treatment commences, then a formal physician- patient relationship is established. Until, this time the family/child is not considered to be a formal patient of the practice.

If treatment commences, the standard CPT codes may include (depending on treatment):

50-min medication/therapy visit (90807/90806)
50-min family therapy (90846/90847)
25-min therapy visit with medication management (90805)
Medication visit (90862)


There is no more sliding-scale at BACA. We now take Medi-Cal patients who live in Santa Clara County.