Click on the “Billing and Payments” tab in the Portal to view your statements and make a secure payment by credit/debit card or a saved account.

You can update personal and insurance information under the "Profile" and "My Info" sections of the Portal.

From your Patient Portal, you can securely add or update a credit card under the “Billing” section. Look for the “Add New Card” option to store a card for future use.

We currently accept these CHIP plans:

• Capital Blue Cross CHIP

• Highmark BCBS-Healthy Kids (CHIP)

• Keystone First Chip

We are not in-network with Tricare. You may need a referral or prior authorization before receiving services, depending on your Tricare plan:

• Tricare Prime: You will need a referral from your Primary Care Manager (PCM). Without it, Tricare may not cover the costs.

• Tricare Select: You do not need a referral, but certain mental health services may require prior authorization.

• Other Tricare Plans (Tricare for Life, Tricare Reserve Select, etc.): Coverage varies, and prior authorization may be required.

Even if you receive a referral or authorization, Tricare will only cover services from a Tricare-certified provider (whether in-network or out-of-network). If a provider is not Tricare-certified, your claim will be denied, and you may be responsible for the full cost of services.

Insurance verification is the essential process of confirming a patient’s insurance coverage for mental health services. It ensures that the patient’s treatment is covered by their insurance, prevents billing discrepancies, and helps the clinic prepare for any out-of-pocket costs the patient may face. This process includes verifying coverage, understanding plan benefits, confirming any required pre-authorizations, and checking for any limitations or exclusions related to mental health services.

Common insurance terms to know:

• Premium: The amount a policyholder pays for an insurance policy, usually billed monthly.

• Co-pay: A set amount the insured person must pay for a covered service, typically at the time of the visit.

• Coinsurance: A percentage of the costs the insured person must pay after the deductible is met.

• Deductible: The amount the patient must pay out-of-pocket before the insurance begins to pay.

• In-network: Providers that have a contract with the insurance company to offer services at negotiated rates.

• Out-of-network: Providers who are not contracted with the insurance company, often resulting in higher out-of-pocket costs.

• Pre-authorization: An approval from the insurance company that must be obtained before certain services or treatments can be provided.

• TPA (Third-Party Administrator): A company that administers claims and benefits on behalf of insurers, especially for specialized services like mental health.

• Carve-Out: A benefit that is managed by a third party, such as a TPA, separate from the primary insurance plan, often for mental health or pharmacy services.

TPAs and carve-out providers manage specialized benefits like mental health services. These companies may handle mental health claims separately from regular insurance policies. When verifying mental health benefits, understanding the role of Third-Party Administrators (TPAs) and carve-outs is essential for ensuring accurate verification.

We work with:

• Quest Behavioral Health – Carve-Out

• Mental Health Consultants – Carve-Out

• Meritain Health – Third-Party Administrator

• Allied Trades Assistance Program – Carve-Out

• Evernorth – Carve-Out

• Luminare Health – Carve-Out

• Optum/United Behavioral Health – Carve-Out

• Surest – Third-Party Administrator (Payor is Surest)

• UMR – Third-Party Administrator (Payor is UMR)

• GEHA (UnitedHealthcare Shared Services) – Third-Party Administrator (GEHA or Optum)

If your plan does not cover the service you need, please contact us to discuss out-of-pocket payment options. Our team may also conduct a standard review of coverage for your services and will notify you of any charges before your scheduled appointment.

Autism Spectrum Disorder (ASD) Evaluation:

• Appointment 1 – Autism Evaluation: $300

• Appointment 2 – Autism Evaluation / ADOS: $300

• Appointment 3 – Autism Evaluation Caregiver Session: $300

Speech and Language Evaluation:

• $300

Occupational Therapy Evaluation:

• $250

If your plan does not cover the service you need, please contact us to discuss out-of-pocket payment options. Your card will be automatically charged on the day of each appointment.

• Initial Visit New Patient Appointment: $350 (collected/charged at the time of scheduling).

• Continuing Care, Medication Management / Diagnostic Review: $250 for your next appointment.

• Subsequent care, Therapy Sessions: $170 per session.

• Subsequent care, Medication Management: $175 for 30–44 minutes or $250 for 45–60 minutes.

External Services: Any services recommended outside of our practice (e.g., labs, testing) may incur separate costs and may accept insurance.