Updated Office Policies
The following office policies have been updated on May 1, 2013 and changes go into effect on October 1, 2013.
Please feel free to contact the office at (985) 231 - 5045 or email us with any questions or comments.
Updated Insurance Billing Policy
McGraw and Associates, LLC
Dr. Kathy McGraw, PhD, MPH, LCSW, LAC, LPP, CEAP
- 50 Wade Street, Suite 5
Luling, LA 70070 - (985) 231-5045
- 3350 Ridgelake Drive, Suite 200
Metairie, LA 70002
Email: Click Here
Frequently Asked Questions (FAQs)
Why are you changing to a direct pay practice?
I went into a mental health, particularly a behavioral and public health practice to help people. Insurance regulations and ever changing health care laws are interfering with my ability to do this. Also, the amount of paperwork I need to complete along with the new rules and regulations I need to learn and follow are now dominating my time and energy. I would prefer to spend time with clients and patients. The consequences for not obeying these rules and laws are substantial and could involve enormous fines or prison time.
Medicare and Medicaid rates have not gone up in over 10 years. Private insurance companies generally follow Medicare and Medicaid’s lead. The cost of doing business has risen at least 25% during this same time period. My practice must survive, as a small business, if we hope to be available to provide for your mental health, public health, addiction, prevention, forensic, and alternative dispute resolution (ADR) needs.
How does this work?
I will provide you with personalized mental health, public health, addiction, prevention, forensic, or ADR services, and you will pay for the services provided. We will post our prices so that you know what to expect to pay. For service that is not listed, we can negotiate a price. We request payment at the time of service, and will happily provide you with an insurance ready receipt to submit to third party payers. If your third party payer allows it, you can send it to them for reimbursement, or to have the amount applied to your deductible or portion of payment.
How is this good for clients and patients?
By taking the insurance companies and the government out of the health care provider – client / health care provider – patient relationship, the health care provider works directly for you. You can be assured that the choices we make for you about your care are not influenced by the regulatory concerns of your insurance company or any other organization. We will be able to respond to your needs, not the demands of the insurance companies or the third party payer.
This also will benefit you because your health care professional will not be bogged down with paperwork and will be more readily available to care for you.
For which clients and patients will this work best?
This type of health care practice will benefit many different types of clients and patients. Clients and patients who have no insurance or who have moderate to high deductibles will probably spend much less money for mental health care in this office. Clients and patients who have PPOs (Preferred Provider Organization) who do not need referrals for care may or may not spend slightly more for care with us, we are confident that the level of service will more than make up for the financial cost. Clients and patients with government insurance (Medicare or Medicaid) will pay more. Again, we are sure that the service we offer will be worth it for most people. For clients and patients who have HMOs with strict network restrictions, this may be a more difficult proposition if they require you to be seen by a health care provider in the insurance company’s network to get referrals.
Will the insurance company reimburse me for these services?
That depends on your insurance company. We will be happy to provide you with a receipt to submit to them. You should check with your individual insurance company to find out.
Can I get reimbursed from Medicare and Medicaid?
The government has very strict rules about this. If a health care provider has “opted out” of Medicare and Medicaid, he / she cannot submit bills to them for at least 2 years. Medicare and Medicaid clients and patients must sign an acknowledgement of this, with the understanding that they are forbidden from asking for reimbursement for our office visits. This contract must be renewed every 2 years, unless the health care provider agrees to start taking Medicare and Medicaid again. These rules apply only to services performed in our office.
I have commercial insurance; can you refer me to specialists?
For clients and patients who have PPO insurance, there is not usually a referral required. For people who have HMOs with very strict network requirements, we may not be able to do referrals for you because of their rules. We strongly recommend that you check with your insurance company to find out if this will present a problem or not. Services that we provide in the office, such as online assessments, will not be billed to your insurance and will be part of our bill to you.
How can you charge a fraction of what you did before and still stay in business?
Because of the way the insurance companies and the government have interfered with the pricing of mental health and health care services, the prices have become overly inflated. It created a system where health care providers were forced to charge far more than they ever expected to receive. Part of the bill goes to offset the administrative costs of cooperating with insurance companies, and allow for mandatory write off amounts.
By cutting out the middlemen, we cut out a lot of confusion, time, and overhead. If we know that we will actually be paid what we charge (like a plumber, bricklayer, or hairdresser), we can cut our rates dramatically.
Why don’t more health care providers practice this way?
ALL of the health care providers with whom we have talked before making our decision to change our practice are concerned about the future of mental health and healthcare. Many, who are frightened of making drastic changes, will try to “ride it out,” hoping that things will get better. Some are selling their practices to large groups and hospitals. Some are becoming concierge health care providers, charging clients and patients over a thousand dollars a year as a retainer fee. Some are leaving mental health and healthcare entirely by retiring early or doing something completely different. Charging people what we feel are reasonable rates and working for them directly fits best with our values. We do not expect to get rich. We would like to survive and thrive. The direct pay model has been working well in other parts of the country. It should work well in Louisiana, as well. Many of the other solo mental health care providers in our area will be watching us. They may make the same changes that we are, if we are successful.
Why must I pay at the time of the visit instead of you sending us a bill?
We could never tell anyone how much a visit really cost in the past, or how much he / she would owe us in the end because every insurance company paid a different rate for the same services. Now, you will know exactly how much the bill will be because we will post our prices in the office and online.
We ask that people pay at the time of service because this helps to keep our costs down, which we, in turn, pass savings on to you. It is really not any different than the way you pay for your groceries when you check out at the supermarket, for your oil change at the mechanic’s, or to have your hair done by your hairstylist or barber.
PLEASE NOTE that we do not want payment to be a barrier for people coming in to see us for their care. If you are financially struggling, please let us know in advance of the visit and we will do our best to work with you.
Will there be any other changes in your practice?
We hope to make a few changes that will make our practice more user friendly, such as updating our website, as well as creating a secure client and patient portal so that people can ask questions, request appointments, and access forms online if they choose.
What will not change is our commitment to serving our clients and patients.
Why shouldn’t I transfer to another practice?
It is certainly your right to transfer your care to another mental health care provider. As most smaller practices are being absorbed by bigger ones, most clients and patients would be going to what we call “big box” practices. They tend to be very big and impersonal. Clients and patients are treated more like numbers or cattle than clients and patients. Many clients and patients see a different mental health care provider every time they go in. Some clients and patients have never met the clinician who is supposed to be their primary mental health care provider after having been in their practice for five years or more! They do not tend to be flexible with getting clients and patients in to be seen when they most need to be. They also are not very flexible with working with clients and patients on their mental health care bills.
We pride ourselves by doing the opposite. We try to be as flexible and personable as possible in meeting our clients’ and patients’ individual needs. When you have an appointment, you will always see the same mental health care provider, who knows you.
We truly hope that you will find enough reason to stay with us, but if you decide that you would like to transfer, we will understand.
Is there a date by which I have to make a decision?
There is no deadline, however, we will be unable to bill insurances effective October 1, 2013. If you come in as of that date, we will ask you to pay for that visit directly.
Can I get an appointment before the change takes effect?
Absolutely, we will do our best to get you in for your regular mental health care appointments if you need one before October 1, 2013. (Before booking appointments, we should be sure you are covered for one so it would be covered under your insurance policy.)
How much will appointments cost after October 1, 2013?
We have cut our rates, since we will no longer have the high overhead involved in billing insurance. Please see the fee schedule below, which has some of our new direct pay rates. Please note that you would be responsible for the current direct pay rate and would receive an insurance ready receipt. If your third party payer allows it, you can send the insurance ready receipt to them for reimbursement, or to have the amount applied to your deductible or portion of payment.