Getting a bill—especially a medical bill—is no one’s favorite thing. Here’s a guide to help you understand exactly what’s on it.
What’s on my bill?
On each bill, you’ll see the details of your visit, how much of it your insurance covered, and any remaining amount you might owe.
Why am I receiving a bill?
To know why you’re receiving a bill, it can help to understand the full process. You see a Talkiatry psychiatrist. After your visit, we will create a detailed bill based on the care you receive. Each visit has a standard cost your insurer has negotiated. We send a bill directly to your insurer, who reviews your coverage. Based on that, they make a determination of how much they’ll cover (Talkiatry doesn’t have a say in this part; it’s based solely on the insurance coverage you have. Your insurer will also send you something called an explanation of benefit (EOB) that will detail their decision) Your insurer will let us know what portion of the bill they believe you’re responsible for. In some cases, it’s a copay. For others, it's coinsurance. If you haven’t met your deductible, it may be for the full amount of the visit.
There’s a “CPT code” on my bill. What is that?
Simply put, CPT codes are shorthand that doctors and insurers use to communicate about the care you receive. They’re standardized and were created to make the billing process more efficient and accurate—for doctors and insurers. Unfortunately, it often raises questions for patients. Here are the answers to the questions we get most often.
There’s more than one CPT code on my bill. What gives?
This is actually fairly common for mental healthcare visits. During visits, our doctors usually provide more than one type of care. For most Talkiatry visits, you’ll see two CPT codes. One is for medical evaluation—checking in about your medications. The other is for psychotherapy. This is for all the other care we provide that goes beyond medications. (We strongly believe that good outcomes stem from a meaningful therapeutic exchange between patients and doctors. That’s why “talk” is a part of our name.)
The psychotherapy code applies to a broad range of things, including talking about exactly how a medication works, discussing or helping manage side effects, discussing coping strategies, additional lifestyle changes like exercise, diet, and sleep hygiene, and addressing any other issues that are related to your diagnosis, such as getting care for other medical conditions. Your doctor will be able to provide a clear explanation of exactly what kind, or kinds, of care they’re providing.
Why is there a code for an “office visit” even though my visit was virtual?
This is just a case where the CPT codes haven’t caught up with the reality of care. To insurers, an office visit and a virtual visit are the same and, most importantly, are covered at the same rate. As virtual care becomes more common, we expect the billing codes to change and more accurately reflect the location of a visit.
Why does the cost of my visits change?
This can be confusing. There are two main reasons the cost of your visits may change. First, the type of visit may be different. A session with a therapist is different than a session with a psychiatrist. Another factor is the type of visit. A first visit that’s 60 minutes and involves an initial evaluation will be billed differently than a follow-up. Second, the specifics of your insurance coverage (usually your deductible or coinsurance) can affect the cost of your visit.