Retirement Notice

This represents formal notification that my private practice of psychiatry will be closing April 5, 2024.

As a result, I am not accepting new patients into the practice. If you are a current patient, I am
committed to assisting in your transfer of care to a new provider.

Joseph Bryer, M.D.

Practice Policies & Information

Practice Information


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.


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 ( 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

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 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).

Notice of Privacy Practices

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by me in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant rights to understand and control how your health information is used. HIPAA provides penalties to covered entities that misuse personal health information.
As required by “HIPAA”, we have prepared this explanation of how we are required to maintain the privacy of your Personal Health Information (PHI) and how we may use and disclose your health information.
We may use and disclose your medical records for each of the following purposes: treatment, payment and health care operations.
· Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include sharing results of a physical examination with another of your medical providers.
Unless you exercise your right to prohibit it, minimally necessary personal health information may be provided to your pharmacy, insurance company or pharmacy benefit manager for any necessary prior authorizations for medications or other treatments.
· Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
Personal health information necessary for billing and insurance operations may be provided to insurance companies with which I am a participating provider (Aetna Dupont and Medicare are the only networks for which I am an in-network provider).
· Health care operations include the business aspects of running my practice, such as conducting quality assessment and improvement activities, auditing functions, cost management analysis and customer service. An example would be an internal quality assessment review.
We may also create and distribute de-identified health information by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
In emergency situations in which I judge that there is imminent risk of harm to self or others which cannot be resolved via intervening solely with the patient directly, I may communicate this risk (along with supporting, minimally necessary medical information) to law enforcement officials, inpatient treatment facilities, putative victims as far as is known, and/or next of kin, as necessary to ensure safety.
Finally, from time to time as necessary, I may provide minimally necessary PHI to my professional liability insurer. .
Except as described above, any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing at any time and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health Information, which you can exercise by presenting a written request to Joseph Bryer, M.D. or other appointed Practice Privacy Officer:
· The right to request restrictions on certain uses and disclosures of protected health information, including disclosures to any person identified by you. If I agree to a restriction, I must abide by it unless you agree in writing to remove it.
· The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
· The right to inspect and copy your protected health Information.
· The right to receive an electronic copy of your medical records.
· The right to submit a written amendment of, or request to amend, your protected health information.
· The right to receive an accounting of disclosures of protected health information.
· The right to restrict the communication of any personal health information by me to your insurance carrier.
· The right to obtain a paper copy of this notice from us upon request.
I am required by law to provide a detailed accounting of any breach, or unauthorized and improper disclosure, of your personal health information.
I am required by law to maintain the privacy of your protected health information and to provide you with notice of my legal duties and privacy practices with respect to protected health information.
This notice is effective as of September 23, 2013, and I am required to abide by the terms of the Notice of Privacy Practices currently in effect. I reserve the right to change the terms of the Notice Privacy Practices and to make the new notice provisions effective for all protected health information that I maintain. I will post and you may request a written copy of a revised Notice of Privacy Practices from this Office.
You have recourse if you believe that your privacy protections have been violated. You have the right to file written complaint with my office, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of my office. I will not retaliate against you for filing a complaint.
For more information about HIPAA or to file a complaint:
The U S Department of Health & Human Services, Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775
If you have any questions or concerns about what you’ve read, or about any privacy or related issue you have in the future, please notify and discuss with me at any time.