Frequently Asked Questions
How do I get out-of-network reimbursement?
To use this benefit, call your insurance company and ask them the following:
- How much does my plan cover for an out-of-network provider?
- What is my out-of-network deductible and has it been met?
- What is my out-of-network annual out-of-pocket cap?
- Do I have to have a “parity” (i.e, severe) diagnosis, to qualify for benefits?
- How many sessions per calendar year does my plan cover for a parity, or non-parity, diagnosis?
- What is the maximum coverage amount (sometimes called the “UCR,” or “usual and customary rate”) for procedure codes listed here (in bold)?
- Is approval or a referral required from my primary care physician?
- Do I need to obtain pre-authorization?
- Are my benefits on a calendar year basis, or a plan year? If on a plan year, when does it start?
Are there any advantages to being seen out-of-network?
- Quality: You/your child are free to get the best clinical care possible, without any interference from the insurance company.
- Access: Appointments can last as long as they need to and can be as frequent as necessary.
- Privacy: If you do not seek reimbursement from your insurance company, your/your child’s chart is completely confidential and will never be released without your permission.
- Financial: Many who do choose to seek reimbursement are surprised to find that the process is relatively simple and the benefits higher than assumed.
How do I get reimbursed by my insurance company on an out-of-network basis?
Once you have paid your balance in full, you simply submit your receipt (which shows all necessary diagnostic and procedural codes and that you have paid) along with your insurance company’s claim form (typically found on their website), either by fax or mail, and your insurance company mails you a check. Insurance companies will not accept claims for dates that have not been paid.
The amount they send you, once you meet your out-of-network deductible and assuming you have obtained any necessary prior authorizations, is based on the percentage of out-of-network coverage your plan authorizes (typically 50-80%) of the allowable rate, which varies based on plan. Please note insurance plans typically do not cover time spent in your/your child’s care in between sessions.
My office will be happy to help you estimate what your actual total cost will be once you call your insurance company and get the information above, and to give you any guidance I can in the process.
Do you accept Health Savings Account, Flexible Savings Account, or Health Reimbursement Account (HSA/FSA/HRA) debit cards?
Yes. If you have a pre-tax account set aside for healthcare expenses, you may use the debit card that is associated with that account. If you do not have one, ask your human resources department if you can set one up.
How do I request a new patient evaluation for myself or my child?
If you are looking for weekly therapy for yourself, or weekly parent strategy sessions, with or without medication management, you may request an appointment by via Luminello, the HIPAA-compliant patient portal for Dr. Braslow’s practice.
If you are looking for medication management alone, please have your therapist initiate the referral.
Please note Dr. Braslow’s practice is exclusively via video (except if otherwise required by DEA regulations), and you/your child must be physically present in California to receive treatment from him. Appointments are via video for 45 minutes, and are in the mornings or mid-day (unfortunately, after-school/evening slots are not available).
What is your cancellation and no-show policy?
Once we schedule your time, I hold that specially for you. As a courtesy to those who are on the wait list, please call me at least two business days before to cancel. For example, if your appointment is on Monday at 4pm, please call me no later than the previous Thursday at 4pm to cancel. If you do not give two business days notice, you will be responsible for the full session fee. Unfortunately, no insurance company reimburses for this. Emergencies are handled on a case-by-case basis.