Insurance Essentials
I do not participate with insurance panels. The reason that I do not take standard insurance comes from my desire to have the flexibility to practice the medical specialty of Psychiatry with its full scope: that is, to know patients well and apply the best research and clinical experience to a problem--like every other medical specialty. Brief, insurance-driven, medication-only appointments (frequently provided by physician extenders and not residency-trained physicians) may be sufficient when a patient has an accurate diagnosis, a viable treatment plan and true clinical stability.
The current insurance-driven system attempts to force many patients into such a treatment model without the patient's true knowledge or consent. The justification of the model is that there is a shortage of psychiatrists. The answer to that is "yes and no". Primary care teams have been on the front line of mental health care for decades and address the majority of problems. But when a patient needs a specialty-trained physician, one should be available. A business model designed to increase profits is not necessarily meeting the best needs of the patient. Psychiatry is a bona fide medical specialty; and it's more than just the pills.
I am deemed an 'Out of Network' provider by insurance companies. Fear not though, services are generally still covered in full or in part by your health insurance or employee benefits plan via your 'Out of Network' mental health benefits.
Please consult your insurance benefits manager or call the telephone number on the back of your insurance card to check the scope your benefits. Some questions to ask could include:
--Do I have mental health insurance benefits at all; do they cover 'Out of Network' physicians?
--Do I have an 'Out of Network' deductible; if so, what will my deductible be, and/or has it been met?
--Is there a dollar limit to what my plan will cover?
The current insurance-driven system attempts to force many patients into such a treatment model without the patient's true knowledge or consent. The justification of the model is that there is a shortage of psychiatrists. The answer to that is "yes and no". Primary care teams have been on the front line of mental health care for decades and address the majority of problems. But when a patient needs a specialty-trained physician, one should be available. A business model designed to increase profits is not necessarily meeting the best needs of the patient. Psychiatry is a bona fide medical specialty; and it's more than just the pills.
I am deemed an 'Out of Network' provider by insurance companies. Fear not though, services are generally still covered in full or in part by your health insurance or employee benefits plan via your 'Out of Network' mental health benefits.
Please consult your insurance benefits manager or call the telephone number on the back of your insurance card to check the scope your benefits. Some questions to ask could include:
--Do I have mental health insurance benefits at all; do they cover 'Out of Network' physicians?
--Do I have an 'Out of Network' deductible; if so, what will my deductible be, and/or has it been met?
--Is there a dollar limit to what my plan will cover?
Rates
Initial Psychiatric Evaluation: 60-90 minutes: (CPT 99205)-- ...........................................$325.00
Full Psychotherapy Session: 50-60 minutes: (CPT 99214 + 90836)--..............................$200.00
Medication Management with Brief Problem-Focused Therapy: 30 minutes:
(CPT 99213)--...................................................................................................................$150.00
Medication Assisted Treatment [MAT] (Suboxone) Evaluation:.........................................$ 325.00
FURTHER IMPORTANT INFORMATION FOR POTENTIAL (MAT) PATIENTS:
--Patients are encouraged to be actively participating in ongoing substance use disorder therapy with Dr. Raines OR another qualified, licensed therapist to meet federal and state treatment guidelines.
--Prescriptions are only given during treatment sessions unless there is a weather emergency affecting the region as a whole or emergency health intervention.
--Each patient will contract with Dr. Raines to obtain their medication from only one pharmacy location.
--Lost or stolen medication cannot be replaced until the next scheduled visit.
Random urine drug screens support patient follow-through with the treatment agreement between the physician and the patient---no one else. Please be aware that drug screens are designed not to be punishment or solely to determine staying or going from buprenorphine (Medication-Assisted Treatment--MAT) treatment. NC state law does not stipulate a rigid frequency or even the manner of obtaining a drug screen. Nor are drug screens designed to be required by insurance companies to allow for reimbursement for treatment. Drug screens alone generally do not prevent relapses; they are designed to aid the doctor and patient to see where gaps in recovery efforts exist. Observed, quantitative, reliable urine drug screens tend to be the most helpful in all spheres. Research shows that MAT works, and patients do well when they follow effective treatment guidelines.
Routine review of the North Carolina Controlled Substances Database by Dr. Raines supports the patient's efforts to seek treatment from only one physician for a diagnosis of Opioid Dependence after meeting the core clinical criteria for outpatient medically assisted treatment [MAT] with Suboxone / (buprenorphine/naloxone).
Cancellation Policy
If a patient simply does not come for a scheduled appointment, and the patient has not notified Dr. Raines at least twenty-four (24) hours in advance, there may be a charge for the full cost of the session. And to the best of Dr. Raines' ability, he will attempt to reach patients by telephone, text or email of any unanticipated changes in scheduling.
