Practice Policies & Information
At this time, my ability to accept new patients is very limited, but would include those seeking second opinion consultations.
The New Patient Information Form should be printed out and completed prior to the first appointment.
Practice Information
Overview
As a psychiatrist, I am a physician who specializes in the treatment of persons with disturbances of moods, thoughts, and behaviors. My general psychiatric training was completed at The Johns Hopkins University and Hospital in 1990. Later work at Hopkins involved specialized training with the elderly and with persons suffering psychiatric complications of neurological disease. Since coming to practice in Delaware I have been employed at various times by Christiana Care and by MeadowWood Behavioral HealthSystem, in addition to private practice. The following is intended to inform you of some details about the psychiatric services I provide, which I am pleased to offer.
Insurance
I do not participate in any insurance company provider networks with the exception of Medicare. I see Medicare patients and "accept assignment". Since I am not in other provider networks, this means that, except for Medicare, you will be expected to provide payment in full at the time of service. Medicare advantage plans are often inconsistent in issuing payment to me for services I provide. I will submit claims for you, but please be aware that you will be responsible for any copayments and may ultimately be responsible for the entire bill.
Medication Prior Authorization Fees
Insurance companies are increasingly demanding prior authorization of many medications that I prescribe. Until the past few years, these authorizations were required for only a few classes of medication. Now, however, prior authorization is required for numerous medications, and in some cases even for generic versions of these medications. It is not uncommon that a patient’s insurance requires prior authorization for two or three (or more) medications I am prescribing.
In the simplest cases, all that is required of me is a phone call of a few minutes to provide information justifying the use of each medication. In other cases, the time requirement is greater, and may involve talking to several people via phone, and often includes also the completion of written information for this purpose. All told, it is not uncommon for the entire process to entail much more than five minutes of my time. Occasionally, prior authorization requires thirty or more minutes to complete. Insurance companies usually do not reimburse me for this time. Therefore, it is unfortunate but necessary that I take the step of asking my patients to reimburse me directly for time I spend in obtaining these authorizations. I will do so according to the following scale:
Prior Authorization Time Requirement (per medication) Fee
Five or fewer minutes: $10
Fifteen to thirty minutes: $45
Thirty to forty-five minutes: $60
I hope that you will address with me any questions or concerns you may have about the above
Contact Information
Telephone messages may be left for me anytime at (302) 426-9440. My recorded message provides an emergency number (usually 302 540-0177) to contact me (or a psychiatrist who may be covering for me) in an emergency. On weekends and major holidays I do not routinely check the answering machine, so any matters that cannot wait until the next business day should be addressed with use of the emergency number above. You may email information to me (jb@josephbryer.com) if you wish, but email should not be used for any care-related issue (since I do not check email regularly or when on vacation or out of the office). Please use the telephone method for all questions or concerns related in any way to your care, such as requests for prescriptions or appointment changes. Also, keep in mind that email may not be sufficiently secure to maintain the confidentiality of medical information. In most cases there will be no charge for brief telephone consultation with me, but especially frequent or especially extensive consultations may be subject to a charge.
Policy on Unnecessary Emergency Calls and Text Messages
Telephone calls and text messages to my emergency number, 302-540-0177, after normal business hours (8 AM to 5 PM weekdays, except for major holidays) are sometimes necessary to communicate urgent or emergency issues. However, such calls and text messages that occur after hours regarding nonurgent issues represent an intrusion on personal time. Therefore, such unnecessary contact with me via my emergency number will incur charges. The minimum charge will be $15 per occurrence for nonemergency issues. The appropriate way to communicate nonurgent issues with me is to leave a voicemail message on my office phone number, 302-426-9440, to which I will respond the next business day.
Appointment Cancellation
Should you need to cancel an office appointment, I expect that you will do so no less than 24 hours prior to the scheduled appointment. This will allow sufficient time to re-schedule other patients who may have an urgent need to be seen. Charges may be billed to you for missed appointments or for sessions cancelled less than 24 hours prior to the scheduled appointment. Unfortunately, insurance companies generally do not reimburse you for such charges.
Accepted Payment Methods
- VISA
- MasterCard
- Advance Payment
- Cash
- Personal Check
No Surprises Act
The No Surprises Act of 2020 went into effect January 1, 2022. This federal law mandates that health care providers notify certain patients in advance of billing charges that the patient should expect for specific services rendered. When a new patient schedules an appointment to see me, I explain at the time the appointment is scheduled what charge to expect, and now I also provide written notification. Charges for any recommended follow-up treatment are verbally explained at the time of scheduling the first follow-up visit, and now I also provide written notification. These requirements apply to self-pay and non-Medicare insured patients, regardless whether provided in person or via telehealth technologies. Below are descriptions (and CPT billing codes) for services I administer, and the charges associated with each specific service, as of January 1, 2022:
Initial diagnostic evaluation, 1 hour (90792 or 90791) $350.00
Psychotherapy, with or without med mgmt, 25-30 min (90832) $150.00
Psychotherapy, with or without med mgmt, 45 min (90834) $240.00
Psychotherapy, with or without med mgmt, 50-60 min (90837) $300.00
Family/couples psychotherapy, 60 min (90847) $300.00
Problem-focused eval and med mgmt, ~15 min (99213) $115.00
Since both Traditional Medicare+Supplement and Medicare Advantage Plans place limits on the amounts that can be collected by participating providers such as myself, providers are prohibited from collecting more than the Medicare allowable amounts. I include Medicare charges in this Notice for the sake of full disclosure. The payments I receive from Medicare are always substantially lower than the charged amounts. Also note that a single Medicare claim often includes multiple charges. For example, it is permissible and common for me to include charges for both an Evaluation and Management service plus an add-on Psychotherapy component. This may clarify why, for Medicare patients, your Explanation of Benefits document often includes two separate charges for the same visit. Typical Medicare services (CPT code in parentheses) and charges are noted below, as of January 1, 2022:
New Patient Moderate Complexity, ~45 min (99204) $250.00
New Patient Comprehensive/High Complexity, ~60 min (99205) $300.00
Established patient, problem focused, ~20 min (99213) $115.00
Established patient, detailed, ~30 min (99214) $135.00
Established patient, complex, ~50 min (99215) $200.00
Psychotherapy add-on, 16-37 minutes (90833) $150.00
Psychotherapy add-on, 38-53 minutes (90834) $240.00
Psychotherapy add-on, 54-65 minutes (90838) $290.00
HIPAA
HIPAA stands for the “Health Insurance Portability and Accountability Act”, a federal law signed in 1996 and implemented April 14, 2003. In essence, the purpose of HIPAA is to set federal standards on the protection of personal health information. There are number of aspects to HIPAA, but two critical ones that were implemented in 2003: the Privacy Rule (having to do with protection of personal information and to whom such information may be released without specific patient authorization) and the Electronic Transaction Rule (having to do with the protection of personal health information during electronic transmission of personal health data, such as via internet and even fax transmissions).