Billing & Payment Information

How the Insurance Claim Process Works

After you attend an appointment, several steps must occur before your insurance company determines your final responsibility.

1. Your Provider Completes the Session Documentation

Your provider must complete and sign the clinical note for the appointment. This documentation supports the services billed and is required before the claim can be finalized and submitted. Most of the time, the session note is not supplied to the insurance company, it is used to generate information for the claim, like time, date, and diagnosis code, etc.

2. The Claim Is Submitted to Insurance

Once the required documentation is complete, the claim is sent to your insurance company using the appropriate billing and diagnosis codes.

3. Your Insurance Company Processes the Claim

Your insurance company determines:

• The allowed or contracted rate
• How much the insurance company will pay
• Whether your deductible applies
• Your copay or coinsurance
• Whether the claim is covered, denied, or requires additional information

4. Your Account Is Updated

After we receive the insurance company’s Explanation of Benefits or claim response, your account is updated to reflect the amount insurance assigned to you.

Because this process depends on both provider documentation and insurance processing, your exact responsibility may not be known immediately after your appointment.

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Why There May Be a Delay Before You Receive a Balance

Insurance claims do not process instantly. A delay may occur because:

• The provider must complete and sign the session note
• The claim must be reviewed before submission
• Insurance processing may take several weeks
• The insurance company may request additional information
• A claim may need to be corrected or resubmitted
• Prior authorization or coordination-of-benefits issues may need to be resolved

We generally use the first processed claim to help determine your expected ongoing responsibility for similar appointments. Once that claim is returned, our team may contact you to explain the balance and what you can expect for future sessions.

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Paying Your Balance

Patients may pay balances securely through our online payment system.

Pay your Dr. Goldberg & Associates balance online

Please have your account information available when submitting a payment.

Accepted Payment Methods

Depending on the location and type of service, payment options may include:

• Credit cards
• Debit cards
• Health Savings Account cards
• Flexible Spending Account cards
• Checks
• Cash

A valid payment method is required to be on file, even when you are using insurance.

Please note that some administrative, documentation, records, and legal-related charges may not qualify for payment with HSA or FSA funds. Contact your plan administrator if you are unsure whether a particular expense is eligible.

Self-Pay Services

Patients may choose to pay privately rather than use insurance. Self-pay may be appropriate when:

• The provider is out-of-network with your plan
• You do not have active insurance
• You do not want a claim submitted
• The service is not covered by insurance
• You are receiving a service that cannot be billed to insurance
• You want greater privacy regarding insurance claims

Self-pay rates vary by provider credentials, service type, and appointment length. Please contact our team before scheduling if you would like an estimate.

Credit Cards on File

Patients are required to keep a valid credit or debit card on file. The card may be used for:

• Copays
• Coinsurance
• Deductible balances
• Self-pay appointments
• Missed appointment fees
• Administrative charges
• Other patient-responsibility balances

You will remain responsible for amounts assigned to you by your insurance company, even when the final amount differs from the original estimate.

HSA and FSA Payments

Health Savings Account and Flexible Spending Account cards may generally be used for eligible clinical healthcare expenses, including covered therapy, medication management, and psychological services.

However, HSA and FSA cards may not be accepted for certain nonclinical or administrative charges, including some:

• Records fees
• Documentation fees
• Legal fees
• Court-related services
• Administrative services

Eligibility is determined by your individual plan. Please contact your HSA or FSA administrator for confirmation.

Checks and Cash

We can accept checks or cash for balances. We do not recommend mailing cash.

Payment Plans

We understand that unexpected medical expenses can create financial stress. If you are unable to pay your full balance at once, please contact the Payment Plan Team as soon as possible. They can be reached at [email protected] or via phone by (703) 935-0058 (Option 5).

Depending on the balance and circumstances, we may be able to offer a payment plan. Payment plans must be approved in advance and may require:

• An agreed payment amount
• A recurring payment schedule
• A valid payment method on file
• Continued payments according to the agreement

Please communicate with us before a balance becomes significantly overdue. We would rather work with you proactively than have financial concerns interfere with your care.

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What Is a Superbill?

A superbill is an itemized document that includes information an insurance company may require when a patient seeks reimbursement for out-of-network services.

A superbill may include:

• Patient information
• Provider name and credentials
• Provider tax identification information
• Dates of service
• Diagnosis codes
• Procedure codes
• Amounts charged
• Amounts paid

A superbill is not the same as an insurance claim. Dr. Goldberg & Associates provides the document, but the patient is responsible for submitting it to their insurance company unless otherwise arranged.

Receiving a superbill does not guarantee that your insurance company will reimburse you.

Why a Superbill May Not Be Available Immediately

A superbill can only be created after the clinical and billing information for the appointment is complete.

Your provider must first complete and sign the session note and the session balance must be fully paid before a superbill can be generated.

This means there may be a delay between the date you attend and pay for the appointment and the date the superbill becomes available.

If you request a superbill immediately after an appointment, the Billing Team may need to wait for the provider’s note before creating it.

How to Request a Superbill

To request a superbill, contact the Billing Team and provide:

• Your full name
• Your date of birth
• The provider’s name
• The dates of service needed
• The email address where the superbill should be sent

Please allow enough time for the provider to complete the required clinical documentation.

Submitting a Superbill to Insurance

Before submitting a superbill, contact your insurance company and ask:

• Whether your plan includes out-of-network benefits
• Whether you must meet an out-of-network deductible
• What percentage of the allowed amount may be reimbursed
• Whether prior authorization was required
• How to submit the claim
• Whether any additional forms are required
• The deadline for submitting the claim

Insurance reimbursement is based on your plan’s out-of-network benefits and allowed rates, not necessarily the amount you paid.

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Legal and Court-Related Services

Legal, court, attorney, subpoena, deposition, testimony, record review, and other forensic or legal-related services cannot be submitted to health insurance.

Examples may include:

• Court testimony
• Depositions
• Attorney consultations
• Legal record review
• Preparation for testimony
• Court-ordered reports
• Custody-related services
• Subpoena responses requiring provider time
• Other non-treatment legal work

These services are self-pay and may require advance payment or a deposit.

Legal services are separate from routine mental health treatment and are not considered standard billable therapy, psychiatry, or testing appointments.

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Updating Your Insurance

Please notify Dr. Goldberg & Associates immediately whenever your insurance changes.

This includes changes to:

• Insurance company
• Plan type
• Member identification number
• Group number
• Policyholder
• Primary or secondary insurance
• Employer-sponsored coverage
• Coordination of benefits

Failing to update your insurance may result in claims being denied or processed out-of-network. If several appointments occur before the new insurance is provided, you may become responsible for a larger balance.

Please provide updated insurance information before your next appointment whenever possible.

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If a Claim Does Not Look Correct

Insurance claims are sometimes processed incorrectly. If your responsibility looks different than expected, please contact both our Billing Team and your insurance company.

Questions to ask your insurance company include:

• Was the provider processed as in-network?
• Was the correct plan used?
• Was the claim subject to my deductible?
• Was the telehealth or in-person place of service processed correctly?
• Was prior authorization required?
• Was the diagnosis or procedure code covered?
• Is coordination of benefits needed?
• Does the claim need to be reprocessed?

Patients should advocate for themselves when a claim does not appear consistent with the benefits they were given.

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Frequently Asked Questions

How much will my appointment cost?

Your cost depends on the provider, service, contracted insurance rate, deductible, copay, coinsurance, and how your insurance company processes the claim. Our team can provide an estimate, but insurance makes the final determination.

Why was I charged after my appointment?

Charges may be added after the insurance company processes the claim and assigns a deductible, copay, coinsurance, or noncovered amount to you.

Why did I pay the full contracted rate even though I have insurance?

If your deductible has not been met, you may be responsible for the insurance company’s full contracted rate. You still receive the benefit of the negotiated in-network discount rather than the full amount of the session out-of-pocket.

Can you guarantee my insurance benefits?

No. Benefit information is an estimate and is not a guarantee of payment. The insurance company determines coverage after receiving and processing the claim.

Can I pay privately even if I have insurance?

In many situations, yes. Please let the scheduling and billing teams know before the claim is submitted so they can explain available options and any applicable requirements.

Can I get a payment plan?

Payment plans may be available depending on the balance and circumstances. Contact the Payment Plan Team to discuss options.

[email protected]

(703) 835-0058 (Option 5)

Why has my superbill not been created yet?

The provider must complete and sign the clinical note before the appointment can be finalized and the superbill can be created.

Will my insurance reimburse me for a superbill?

That depends on your out-of-network benefits. A superbill provides the information needed to request reimbursement but does not guarantee payment.

Can legal services be billed to insurance?

No. Legal and court-related services are self-pay and cannot be submitted to health insurance.

Can I use my HSA or FSA card?

HSA and FSA cards may generally be used for eligible clinical services. They may not be accepted for certain administrative, records, documentation, or legal charges.

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Contact the Billing Team

Please contact our Billing Team if you have questions about:

• Insurance benefits
• Claim processing
• Copays, deductibles, or coinsurance
• Account balances
• Self-pay rates
• Superbills
• Denied or incorrectly processed claims

When contacting the team, please include your full name, date of birth, provider’s name, and a brief description of your question. Avoid placing sensitive medical information in the email subject line.

[email protected]

(703) 935-0058 (Option 3)

Please contact our payments team if you have questions about:

• Payment options
• Payment plans

When contacting the team, please include your full name, date of birth, provider’s name, and a brief description of your question. Avoid placing sensitive medical information in the email subject line.

[email protected]

(703) 935-0058 (Option 5)

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Make a Payment

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Pay your balance securely online

We encourage you to contact the Billing Team if you need clarification or assistance before submitting payment.