CHERYL WASKIEWICZ, APRN

Amity Mental Health.com
AmityMentalHealth@gmail.com

Fees & Insurance Claims

FEES


>> $140 for MEDICATION MANAGEMENT services, which includes 15-30 minute visit, access to me between appointments for medication monitoring and questions/problems, refill services, maintaining prior authorization for medications, and maintenance of essential collaboration with your psychotherapist and/or medical healthcare provider if/as needed.  Effective Oct 2015, Connecticut law requires me to check the controlled substance database if I am prescribing a controlled substance. 


>> $270 for PSYCHOTHERAPY, which includes 50-60 minute session, with or without medication management.

>> $270/ hour pro-rated for CASE MANAGEMENT tasks that require more than ten minutes of my time (for example, writing a letter, completing complicated forms).  Most problems and questions that arise between appointments can be managed in under 10 minutes by email or phone; this service is included in the above fee structure, and ensures economic, efficient services while maintaining best clinical practices and safety.  I will ask you to make an appointment only if I think  it is necessary.



>>>>>>>><<<<<<<<<<<<<<<<


INSURANCE  CLAIMS


My services are very often covered in full under your insurance policy's "out-of-network" benefits, HSA (Health Savings Account) or FSA (Flexible Spending Account).

Following an appointment, I will provide you with a "Superbill" invoice that contains all the information required by your insurance company to submit a claim for reimbursement.  You must attach my Superbill to your insurance company's Claim Form.   Select the link below for your insurance company  and follow the instructions.  If your insurance is not listed, call the Customer Service phone number on the back of your insurance card and request assistance with submitting a claim for "out-of-network" services.



AETNA:   https://www.aetna.com/individuals-families/member-tools-forms/find-form.html


CIGNA:  http://apps.cignabehavioral.com/web/basicsite/consumer/customerService/oon_claim_form.pdf

CONNECTICARE:  http://www.connecticare.com/member/globalFiles/forms/cc0027.pdf

HEALTH SMART:
FSA:  http://www.healthsmart.com/PDFs/Forms/FSA-remimbursement.pdf
Claims:  http://www.healthsmart.com/PDFs/Forms/MedicalClaimForm.pdf

HUMANA:  https://www.humana.com/individual-and-family-support/tools/member-forms

UNITED HEALTH CARE/ UNITED BEHAVIORAL HEALTH:  https://www.liveandworkwell.com/public/help/forms.asp?lang=1

VALUE OPTIONS:  (can be completed online or sent by mail):  https://ets.valueoptions.com/OnlineClaimSubmission