KINGA PASTUSZAK, PSY.D.
LICENSED CLINICAL PSYCHOLOGIST
INFORMATION
PRIVACY POLICY
I comply in strict accordance with federal and state laws, as well as rules of the profession, to assure that you receive competent and ethical treatment. I adhere to the Privacy Rules established under HIPAA, the Health Insurance Portability and Accountability Act. A copy of the Notice of Privacy Practices will be provided to you.
PAYMENT
I am an In-Network provider for Blue Cross Blue Shield (BCBS) and Tufts insurance plans and am a participating provider for Medicare Part B.
I am also an Out-Of-Network provider for most PPO insurance plans, including Harvard Pilgrim, Aetna, and Cigna.
Payment by cash, credit card or check is due at the time of service, unless an alternate agreement is made.
INSURANCE
When working with your insurance company, do not be discouraged by, or assume you need to navigate alone, what sometimes feels like a daunting task. I will be glad to consult with you on the process of obtaining a clear understanding of your benefits.
To determine your insurance benefits and eligibility, contact your insurance by calling the Mental Health phone number located on the back of your insurance card. A representative will assist you.
To ensure that you receive all the information that will be helpful to you, below is a list of important questions to ask:
● What is my benefit for mental health?
● Specifically, what is my benefit for outpatient individual psychotherapy?
● Do I have an out-of-network benefit? Or, do I only have in-network benefits?
● Is the provider I’d like to work with considered in-network or out-of-network for my current insurance plan?
● Do I have an annual deductible? If so, on what date does my annual calendar start? (this is typically the date your insurance was activated)
● Do I have a coinsurance payment? How much is it per visit?
● Do I have a maximum on my out-of-pocket expenses?
● Do I have to obtain authorization in order to use my benefits/participate in sessions?
● Does my benefit become unlimited, as determined by medical necessity, if my diagnosis is biologically based? (Parity Law)
● Are my benefits different for substance abuse treatment?
● How do I obtain reimbursement for treatment I have paid for out-of-pocket?
● What is your name and call-back number (for follow-up with additional questions and to document information provided)?
