Insurance Coverage

Health insurance plans may vary considerably in their mental health coverage and benefits. You may wish to check your health insurance policy to understand how mental health services are covered under your plan. Sometimes you will find a toll-free number on your health insurance card that you can call to ask questions about your health insurance plan.

OCPS does not maintain a list of psychiatrists who are "preferred providers" or contracted panelists with a given health insurance plan. However, you may find the following points helpful.

Often, health insurance companies will offer a directory of providers who are in their network. If you are looking for a provider covered by your insurance, you may wish to consult such resources published by your insurance company in conjunction with the information found in the OCPS Physician Directory.

Do you have a PPO, POS, EPO, or HMO plan?

Generally speaking, PPO (Preferred Provider Organization), EPO (Exclusive Provider Organization), and POS (Point of Service) plans will reimburse at a certain level for "in network" providers, who are psychiatrists "paneled" with the insurance company and who have agreed to a pre-arranged level of reimbursement. PPO and some POS plans may reimburse for services provided by out-of-network providers, although reimbursement for these providers may be at a lower level than for providers who are "in network. HMO (Health Maintenance Organization) and EPO plans normally will not provide reimbursement for providers outside of the network.

When contacting a prospective psychiatrist, you may wish to ask if they take your specific insurance plan. You may find that some psychiatrists operate entirely outside of insurance. Such psychiatrists may ask for payment directly from the patient, and most of the time he or she will give you a "super-bill" receipt you can use to bill your insurance if you would like to seek reimbursement.

Do you have Medicare?

Many people 65 and older, and some others, enjoy the benefit of Medicare insurance, provided by the Federal government. While some psychiatrists accept Medicare insurance, others may have chosen to "opt-out" of Medicare and are not covered by Medicare. When contacting a physician in our directory, you can ask if they take Medicare. Often, people with Medicare insurance also have a supplemental insurance program, which may reimburse some portion of the fees charged by psychiatrists who have opted-out of Medicare. The specific amount of reimbursement depends on your type of supplemental plan, similar to those plans described above, and several other factors such as the type of service provided.

Another resource where you can look for psychiatrists who take Medicare is Medicare.gov.

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