Anthony A. Chico, III, D.O., L.L.C.
I appreciate the opportunity to work with you and/or your family. The following information describes procedural matters important to my patients. Please read this material. If you have any further questions, feel free to discuss them with me.
Confidentiality: All communication between therapist and patient is held in the strictest confidence unless: 1) The patient authorizes release of information with a signature; 2) The therapist is ordered by a court to release information; 3) Child or elder abuse/neglect is suspected; 4) I become concerned for the patient's or the safety of others. In the latter two cases I am required by law to inform legal authorities and/or potential victims.
Insurance: Most health insurance plans provide for some outpatient mental health benefits. Please note that I am considered a "non-participating provider" with the insurance companies and will not be able to receive payment directly from any insurance company, only from the patients themselves. Because I am not a member of any insurance plan or network you may be reimbursed by your insurance company at a lower rate than for "in-network physicians."
Generally, you should be able to collect directly from your own insurer if you follow these steps: I will send you a written statement at the end of each session to show what you already paid at the time of each visit. This statement can be submitted to the insurance companies for reimbursement directly to you. You simply need to fill out your own insurance form, attach the statement, and send these to your insurance company, asking them to pay you, rather than myself (Dr. Chico). If there is no place to specify paying you rather than the doctor on your form, then write the following in red, somewhere on your insurance form: "PAY SUBSCRIBER, NOT PROVIDER."
Please determine what your insurance plan requires of me in order to process a claim. I will make every effort to meet the insurance plan's requirements. I will fill out the insurance treatment plans for patients who attend treatment more often than every 3 months. This will allow patients to obtain "medical authorization" for insurance to reimburse them at out-of-network rates. If the patient comes less frequently than 3 months I will also fill out treatment plans but at the cost of $45 per treatment plan. Be aware that these insurance treatment plans often ask for fairly confidential information to "justify" treatment. It is your responsibility to learn what coverage is provided by your plan and to submit insurance claims.
Payment: All payments (cash, check, debit, Visa, Master Card, Discover, American Express, or Diners Club) are due in full at the end of each session. At the end of the session, a summary statement of services provided will be sent to you. Accounts more than 30 days in arrears may be assessed a monthly finance charge of 2%.
Initial Evaluation/Single Consultation Evaluation, New Patient (1.5hrs): $400
Individual/Family Session (50mins): $220
Individual Session/Medication Management (25mins): $140
Court Appearance (60mins): $600
(Please note: I am NOT a forensic psychiatrist)
Cancellation Policy: When you agree on a scheduled time, that time frame will not be offered to another individual. Often this means that patients need to be turned away because an adequate alternative time cannot be found. Canceled and missed sessions cannot always be filled. For these reasons, you are asked to assume responsibility for your scheduled time. Therefore, you will be expected to pay for your appointment even if you do not come; unless you cancel prior to 24 hours before the scheduled time. However, there will not be a charge for a missed appointment if it is missed due to a genuine emergency, or if your time can be filled by another patient at the last minute.
Messages/Emergencies: You can leave messages by calling 410-828-0103 throughout the week and weekend. I will make every effort to return calls promptly. Occasionally, however, there may be a delay. If it is an emergency, please follow the instructions on the voice mail to reach me directly. If for some reason you are not able to immediately contact me, in the case of an emergency, you should either call 911 or contact the emergency room of your local hospital.
Coverage: When I am away, or unavailable, I will arrange coverage from another psychiatrist. If it is necessary to visit that other psychiatrist while I am away, his or her own professional fees and policies would apply to that visit. My voice mail will state which doctor is covering.