To ensure a smooth intake process, please provide us with your complete insurance details. Surround Me Mental Health PLLC (SMMH) requires your valid debit/credit/HSA/FSA card information on file prior to the initial visit, which can be self-entered into your patient portal when you’re invited to do so. If you do not already have the information, please contact your insurance company regarding your copayment, deductible, coinsurance so you know if you would be responsible for zero, part or all the cost of the services provided to you. Patients are responsible for full payment, whether the insurance company ends up paying partially, or not at all, for services rendered by SMMH.

If SMMH is out-of-network, patients will pay the full cost of services out of pocket. SMMH can provide superbills that patients can submit to insurance companies for reimbursement. If SMMH is in-network but you are yet to meet your deductible, you will be expected to pay the maximum payment out of pocket that the plan will pay for covered health care services. If you’ve met your deductible, you’ll only need to pay your coinsurance or copayment amount, if applicable. All payments are due at the time of service.

Insurance: In-Network

Currently, SMMH is in network with the plans listed below. We are in the process of credentialing with other insurance companies. For in-network services, SMMH will submit claims on your behalf as a courtesy, but there is no guarantee that your insurance will pay.

  1. Premera Blue Cross: Global, Heritage, Life Wise.
  2. First Choice Health: Kaiser Foundation, Pacific Source, Providence, Wellfleet Insurance Company.
  3. Cigna: HMO, PPO, Third Party Administrator, Employee Assistance Programs, SureFit, Local Plus, Self-Insured Employers, Medicare, Disability Management Programs, Worker’s Compensation.
  4. Regence
  5. Medicare

Insurance: Out-Of-Network

Currently, SMMH is considered out of network with other insurance companies. This means that the fees below will be paid in full for the services provided by the provider if the patient does not carry one of the insurances listed above. SMMH will be able to provide you with superbills that you can present to your insurance for reimbursement.

Payment

You agree to pay professional fees as follows:
Indiana:

  • Currently accepting private pay only.
  • SMMH is actively working with insurance companies to be able to accept health insurances.

Washington:

  • $345 for approx. 60 minutes psychiatric evaluation.
  • $195 for approx. 30 minutes follow up appointment.

Please ask us for a good faith estimate after your first visit.

Other Forms Of Payments

  • Credit/debit cards
  • HSA/FSA
  • Zelle
  • Venmo
  • Check
  • We do not accept cash.

Fees For Cancellations, No-Shows, Other Professional Services

To ensure that all clients are seen in a timely manner, Surround Me Mental Health (SMMH) adheres to a cancellation policy. Please give us at least 24-business hour cancellation notice as needed. For example, if your appointment is on a Monday at 4 PM, please let us know about the cancellation no later than the previous Friday at 4 PM. If an appointment is on a Wednesday at 10 AM, please let us know no later than Tuesday at 10 AM.

For no shows/cancellations with less than 24 business hours’ notice, SMMH will not charge for the first occurrence. If this continues to happen, you will be charged 50% of the cost of the service. If you are more than 5 minutes late for a 30-minute appointment, SMMH will call your attention to the initial occurrence without being charged. If the incident continues to occur, your appointment may be cancelled and be charged 50% of the cost of the service.

SMMH understands the possibility of unforeseen circumstances that could result in not keeping or being late to your confirmed appointments. However, it is vital for us to be consistent with the policy to be fair to all clients.

There are times when services will need to be rendered outside of session time. Unfortunately, insurance companies typically do not reimburse for these. Below are some of these services with the fees that may be charged:

  1. Prescription refills outside of session time: $25.
  2. SMMH will not charge for short emails. Phone calls, messages in the patient portal, letters, video sessions and long texts between the provider and you, your child, other physicians, therapists, teachers, family members, etc. will be charged $50 for each 10-minute increment.
  3. Coordination of care for emergencies, hospitalization, intensive outpatient, residential treatment, rehabilitation, etc. will be charged $50 for each 10-minute increment.
  4. All forms (insurance, worker’s compensation, school, employer, doctor’s notes, letters, or reports) and chart reviews not filled out in session will be charged $50 for each 10-minute increment. Unfortunately, SMMH is unable to fill out certain forms, such as some immigration paperwork. The provider will not complete certain forms at the initial visit and will require familiarizing himself with your health conditions before doing so.
  5. There will be no charge for services provided under 10 minutes.
  6. There is a $25 fee for returned checks (which will also result in your credit card automatically being run for the balance due) and for credit card chargebacks that are unsubstantiated