Insurance Policy

As an out-of-network provider, Elise Scott, M.D. is not contracted with nor will accept payment from insurance companies. Additionally, Elise Scott, M.D. opted out of Medicare.

Dr. Scott is happy to provide you with Superbills which are unique invoices with relevant medical codes that you can submit to your insurance carrier for complete or partial reimbursement for our services. If you plan to file a claim with your insurance carrier, it is recommended that you contact your insurance carrier in advance to verify your out of network benefits and find out how your insurance may reimburse you for care with Dr. Scott. Most health insurances offer reasonable out-of-network benefits and should be able to assist you with the reimbursement process. However, it is not possible to submit your claims for reimbursement to Medicare or Medicaid as they do not offer out-of-network benefits. Patients who have Medicare insurance policies must sign the federally mandated “Private Contract” to receive services paid privately. Please notify us if you have Medicare insurance so that we can assist with the signing of this form.

 It is your responsibility to understand your insurance plan and seek information about the company’s reimbursement process. You may find answers to these questions in your insurance Summary of Benefits or your insurance company’s website. We recommend calling your insurance company to verify your benefits. You can usually find this phone number on the back of your insurance card. Dr. Scott cannot and does not guarantee insurance reimbursement of any kind because those are services provided by the insurance carrier.

Recommended questions to ask your insurance company about out-of-network benefits:

• Do I have out-of-network outpatient mental health benefits?

• If I have out-of-network outpatient mental health benefits, what percentage or dollar amount will I be reimbursed for psychiatric consults/appointments?

• Is Telehealth/Telemedicine/Telepsychiatry covered by out-of-network benefits?

• Do I have an annual deductible? If so, how much is it, and how much of my deductible has been met for this year?

• If I have a deductible, will I need to pay out of pocket for the out-of-network psychiatric appointments until that deductible has been met? After the deductible has been met, what percentage or dollar amount will I be reimbursed for out-of-network psychiatric appointments?

• What documentation do I need to submit to receive out-of-network psychiatric appointments reimbursements?

• Do I need a referral from an in-network provider to see an out-of-network provider?

Of note, there are many benefits for patients who choose private pay treatment instead of using insurance, including:

• Freedom to choose a clinician who is the best fit for your needs

• Freedom for you and your provider to determine the course and length of treatment

• Increased confidentiality for you and your clinician (diagnosis and treatment is not accessible by life, disability, or health insurance companies)

• No restrictions on telehealth

• Continuing to work with the same provider even if your health insurance changes

If you need help submitting claims, there is a service called Reimbursify (https://reimbursify.com) that will submit the insurance reimbursement paperwork for you.

Payment Policy

Payment is due in full at the time of each appointment. By default, this will be automatically charged to your preferred credit card safely and securely managed within the electronic health record. If you prefer an alternative payment agreement or to use an alternate form of payment, please notify Dr. Scott during your appointment. No one employed by Elise Scott, M.D. PLLC can view or access your credit card information.

Your payment information must be added before the initial appointment. If you do not have a credit card on file or your card is declined, we will call or email you to discuss possible adjustments to your payment methods. Dr. Scott may discontinue treatment if there are unpaid balances.

Under circumstances of unusual and demonstrated financial hardship, we can sometimes temporarily continue services for a reduced or waived fee. If an account is more than 60 days past due, without an established payment agreement, the agreement may be remanded to a collection’s agency or small claims court. If such legal action is necessary, its costs are typically included in the claim.

Cancellation & Missed Appointment Policy

Elise Scott, M.D. PLLC kindly requests that you provide at least 48 business hours advance notice of cancellation, or 24 hours prior to rescheduling. Late changes or missed appointments will result in a 50% charge to your account. In some emergency cases, this fee may be waived, such as the death or birth of a family member, an accident, or serious illnesses or injuries to yourself or someone you care for. Work or travel-related conflicts will not be exceptions to this policy.

Paperwork Policy

Requests to complete forms or other paperwork (such as FMLA or disability) outside of your appointment time will result in additional charges that reflect hourly rates. The fee will depend on the time needed to complete forms appropriately, and this may include writing, chart review for supporting clinical documentation, preparing/sending faxes, and other administrative tasks. 

Good Faith Estimate

Health care providers are required to give new, prospective, or established patients a good faith estimate of costs for services that they provide. While it is not possible for Dr. Scott to know, in advance, how many sessions may be necessary or appropriate for a given person, this form provides an estimate of the cost of services rendered that are provided per session. Your total cost of services will depend upon the number of clinical appointments you attend, your individual circumstances, and the type and/or amount of services that are provided to you. Dr. Scott will collaborate with you throughout your treatment to determine how many sessions and/or services you may need to receive the greatest benefit based on your diagnosis(es)/presenting clinical concerns. This estimate is not a contract and does not obligate you to obtain any services from Elise Scott, M.D., nor does it include any services rendered to you that are not identified here.

This Good Faith Estimate is not intended to serve as a recommendation for treatment or a prediction that you may need to attend a specified number of appointments. Many patients will attend one visit every four to twelve weeks, but the frequency of visits that are appropriate in your case may be more or less, depending upon your needs. The number of appointments that are appropriate in your case, and the estimated cost for those services, depends on your needs and what you agree to in consultation with Dr. Scott. You are entitled to disagree with any recommendations made to you concerning your treatment and you may discontinue treatment at any time.

The amount below is only an estimate, and it is not an offer or contract for services. This estimate shows the full estimated costs of the items or services listed. This means that the final cost of services may be different than this estimate.

Good Faith Estimates:

• Initial Psychiatric Evaluation 75-90 minutes: $450

• Follow-up Appointment 25-30 minutes: $200

• Follow-up Appointment 50-60 minutes: $350

• Prescriptions outside of an appointment: $30

• Communications/paperwork that require tasks longer than 5 minutes: $75 per 15 minute increment

• Missed appointments or cancellations less than 48 hours in advance may be charged 50% of the cost of the schedule appointment

The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. In those cases, we recommend that you contact us to note that the billed charges are higher than the Good Faith Estimate. You can ask to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available. 

You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill. There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you and agrees with the health care provider or facility, you will have to pay the higher amount. To learn more and get a form to start the process, go to www.cms.gov/nosurprises. Most importantly, starting a dispute will not adversely affect the quality of health care services at Elise Scott, M.D. PLLC.