Payment

 

Dr. Quiroga is excited to offer a Direct-Care Psychiatry Model.  With this model, insurance is not accepted and payment is made directly to Dr. Quiroga, Ascend TMS PLLC, at the time of service.  We accept Cash, Check, Debit Cards, Credit Cards and HSA/FSA (Please note that there is a 3.5% credit card fee. There is no fee from debit cards).

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Professional fees are as follows: 

•          Comprehensive Psychiatric Initial Evaluation:

            up to 90 minutes $550.00

•          Comprehensive Follow Up Appointments:

            25 min $225.00

            50 min $450.00

•          Initial Focused ADHD Evaluation:

            $350.00

•          Focused ADHD Follow Up Appointments:

            $225.00

            

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This Direct-Care Model allows for more personalized care, with greater access to timely appointments, and ease of communication.   This also means that your Psychiatric treatment will remain confidential between you and Dr. Quiroga, and does not have to become part of your permanent medical record with your insurance company. In addition, you and Dr. Quiroga can decide on the length of your visits and are not restricted to a length of session or frequency that may be dictated by your insurance provider.  

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"How can my Insurance Company reimburse me for the visits?"

If you would like to submit your charges to your insurance provider for reimbursement, a superbill can be generated by AscendTMS PLLC at your request.  Dr. Quiroga will be considered an “out of network” provider, in most cases. 

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• You may be able to submit to your insurance for out-of-network  reimbursement.  

• Some insurances will deduct out-of-network visits from your deductible.  

 

Please contact your individual insurance carrier for their policy on out-of-network visits and reimbursement.   Our office does not submit to insurance companies on your behalf.

 

Payment Agreement

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Welcome to my practice.  Your agreement to the following terms and conditions is required for you/your child to receive professional services from me.  

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Professional fees are as follows: 

•          Comprehensive Psychiatric Initial Evaluation:

            up to 90 minutes $550.00

•          Comprehensive Follow Up Appointments:

            25 min $225.00

            50 min $450.00

•          Initial Focused ADHD Evaluation:

            $350.00

•          Focused ADHD Follow Up Appointments:

            $225.00

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You agree to pay for any time spent in your or your child's care outside of session time on a prorated basis (unless otherwise detailed below). Prorated fee for services rendered outside of session time is $75 for 10 minutes.  Unfortunately, insurance companies typically do not reimburse for this. Some examples include, but are not limited to:

•  No shows/rescheduling with less than 24 business hours notice: full session charge.  For example, if you or your child’s appointment is on Monday at 4pm, you will communicate your cancellation no later than the previous Friday at 4pm; if an appointment is on Tuesday at 10am, you will communicate no later than Monday at 10am.

• Phone calls, messages in the patient portal, voicemails, letters, video sessions and texts between me and: you, your child, or other physicians, therapists, teachers, family members, insurance companies, etc.

• Prescription refills outside of session time

• Time spent obtaining prior authorizations

• Coordination of care for emergencies, hospitalization, intensive outpatient, residential treatment, rehabilitation, etc.

• All forms (insurance, worker’s compensation, school, employer; doctor’s notes, letters, or reports) and chart reviews not filled out in session

• Testimony in court, at depositions, administrative hearings, board reviews, and all time required for preparation and travel, whether requested by you or ordered by a court, board, government agency or other legal authority

 

You are financially responsible for all charges, whether or not:

• Insurance pays for any services

• We decide to proceed with treatment

• Treatment is successful, for which there cannot be any guarantee

You affirm you are an authorized user of the credit card whose number and expiration date supplied, and you do authorize its use for all fees incurred.

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A copy of our payment agreement will be available for signature at your Initial Consultation.  

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Understand your right to have a good faith estimate of expected charges

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