Which insurances does Dr. Spellman participate with?
Dr. Spellman is a private pay psychiatrist who does not take any insurance but chooses to not participate with a system she considers unethical. Read on to learn about how the current insurance-based health care system can adversely affect you if you use it for mental health care.
All insurances require that you be given a mental health diagnosis if they are paying for your mental health treatment. Many people do not realize that having a mental health diagnosis on their permanent record can come back to hurt them either now or in in the future. It can be used as an excuse for life insurance or long-term-care insurance to be denied. It can also raise questions when people go to renew their professional licenses.
What is more, the Insurance companies prefer, perhaps even mandate, that all medical records be electronic records and not paper. Dr. Spellman believes this is because the insurance companies can access electronic records when they are paying for the treatment. CDPHP, MVP, and BlueSHield of Northeasetern New York, for example, have been part of of creating an information sharing system known by the acronym HIXNY. which stands for the Capital Healthcare Information Xchange of New York. It is a network that allows all your other providers and ancillary entities in the HIXNY network total and immediate access to your electronic medical records.. While this may be a good thing for general medical emergencies, it destroys the confidentiality of mental health care. delivered by providers who accept insurances.
Another interesting fact is that when providers accept your insurance, they get paid more if they write in the records that you are doing poorly and have complicated problems for which they are treating you. This is true for any medical specialty including psychiatry.
Insurance companies and their “business associates” would not have access to your records with Dr. Spellman because she as a private pay provider is not forced to share your mental health records with HIXNY nor is she forced to use use electronic medical records. She keeps all records on paper.. The only thing that Dr. Spellman does electronically is to prescribe medication, because New York State requires that all prescriptions be sent to the pharmacy electronically.
When Dr. Spellman orders labs, she orders them on paper. She does have to write down a diagnosis code in order for the insurance to pay for the labs, but she is sensitive about labels that you do not already have on record.
In short there is no such thing as absolute privacy in the current health care environment. BUT THERE IS MUCH MORE PRIVACY IF YOU DO NOT USE YOUR INSURANCE. Chances are the pharmacies and labs - even though they get your insurance to pay -will not take the time to look up the fact that Dr. Spellman is a psychiatrist. And they certainly have NO ACCESS to your records with Dr. Spellman.
That being said, perhaps you are not that concerned about insurance knowing you are seeing a psychiatrist – as long as they do not know all the graphic details (as they and all the HIXNY network would if you went to a provider who accepts insurance). In that case, you can ask Dr. Spellman for PAPER claim forms and then you can mail them to your insurance if you have Out of Network benefits. It is best to call your insurance first, as explained in the panels below, to find out how much, if anything, they would reimburse you.
Now that you know how the system works you can decide what is best for you.
What do I ask when I call my insurance to find out how much they would reimburse me?
If you call your insurance, tell them Dr. Spellman is an Out of Network MD-psychiatrist and that she will be spending 55 minutes with you each session. The "procedure code" for the first session is always 90792. Subsequent sessions are coded differently. The two "procedures" Dr. Spellman will typically combine during those subsequent 55-minute sessions will be an Evaluation and Management code and a Psychotherapy add-on code. Typically she will be combining 99214 with 90833 OR 99213 with 90836.
Are Dr. Spellman's fees affordable?
Dr. Spellman offers two different highly discounted 4- session packages since most people need at least 4 sessions to get back on track. Call or text her for details. She will want to speak with you briefly and learn what your needs are to see if she thinks she can help you - before she makes an appointment with you.