Jacqueline Hubbard, M.D.

I’ve frequently seen insurance have negative affects on patient care, and have experienced these effects firsthand.  Before getting into the list of reasons I do not accept insurance, I want to be clear that I do not ask patients to see me more frequently than what I believe to be necessary, so the financial impact from my treatment plans may be lower than you expect.  I also have no problem discussing my recommendations, so if you are my patient and are interested in the reasons behind why I recommend a specific period of time to your next appointment, please ask.  I never want a patient to feel like an appointment was unnecessary.

The following are the primary reasons I do not accept insurance:

Privacy – Unless you request, and authorize, my discussing your, or your dependent’s, treatment with others, I am the only person who knows you have received, or are receiving, any services at my practice.  I see many patients where privacy is of great concern; adults who want healthcare that doesn’t involve their employer’s insurance plan, parents who want to minimize the number of people with knowledge of a child’s treatment, and many other similar situations.

Treatment Options – I am not limited, or instructed, by an insurance company on what types of treatment I can recommend.  I am not prevented from creating what I believe to be the most effective treatment plan for each patient.

Patient Control – You decide if you or your dependent would like to see me, we discuss your concerns to see if I am an appropriate physician for you before an initial appointment, and if we proceed, it is solely your decision to do so.  You do not need a referral from your primary care provider, or permission from your insurer, to begin treatment.  Most importantly, your insurance provider doesn’t dictate when you can see me, for what duration of time, or when you can or can’t continue seeing me.  Parts of the processes I’ve just mentioned are referred to as a “prior authorization” where you need a referral, or I must seek insurance company approval, before your first appointment, or in some cases, before every appointment, and that can cause scheduling problems for patients who have an urgent need.

Quality of Care – Insurance companies create numerous barriers to providing the highest quality care, not the least of which is a very low reimbursement rate for mental health services.  Low reimbursement rates are a large factor in what leads other providers to double and triple book appointments, minimize physician involvement with each patient, over-burden office staff leading to very poor customer service, and reduce appointment durations to lengths I do not consider reasonable.  Some insurers would prevent my ability to offer enhanced services, such as prohibiting appointments over computer video chat.  Insurance billing and processing of payments can often be described as simply horrible, and the administrative overhead from that activity would greatly reduce the amount of time I can spend on patient-focused tasks.  I prefer to handle all patient interaction and devote my full attention to my patients for well-above-average appointment lengths.

“I would like to see an out of network psychiatrist.  Do I have out of network benefits?”

If they say no, then you do not have out of network benefits.  That would mean that seeing me would involve your paying for my services and your insurer would provide no reimbursement.

If they say yes you do have out of network benefits, you will want to find out the details of those benefits, and if there is any out of network deductible.  Many insurance plans will pay some percentage of a bill for out of network coverage, but it may have restrictions, so you’ll want to get the full details from your insurer.

If your insurer says the out of network benefit is specific to the type of treatment you receive, here is the information you will want to ask them for, and my explanation of each code:

Please let me know how I would be reimbursed for the following billing codes:
90792, 99204, 99205 (I use one of these for initial evaluations; the relevant one depends on the patient)
99214, 99215 (I use one of these for follow-up appointments)
90833 (I may use this in addition to the above for certain patients)
90785 (This code may be used for patients under 18)

If they give you your out of network benefit or specific reimbursement amounts for the above codes, you should be able to determine what amount you’d get back from them.  I can assist you with this.

Missed appointments, or those not cancelled pursuant to this policy, will result in an obligation to pay the normal fee associated with the appointment prior to rescheduling.

For an emergency, please immediately call 911.  Additional emergency resources include PEMHS (Personal Enrichment through Mental Health Services, http://www.pemhs.org/) who offers a 24-hour suicide prevent hotline at 727-791-3131 and 24-hour mental health assistance at 727-541-4628.  As the above contact info for PEMHS may change, please check their website to ensure accuracy.

The toll free national suicide prevention lifeline is 1-800-273-TALK (8255).

If you do have an urgent (non-emergency) issue to discuss, please leave a voicemail message.  When possible, I check messages periodically outside of normal business hours.

A psychiatrist with current board certification is someone who has completed additional training in psychiatry after receiving their Doctor of Medicine degree, and who is required to complete ongoing education and periodic re-certification examinations.  In the case of the child & adolescent board certification, this includes a minimum of two years of training specific to treating children and adolescents, and makes the physician eligible to take that board exam.

If your child sees a psychiatrist who holds a child & adolescent board certification, you are ensuring they’ve had specialized training, that they participate in continuing education, and that they have periodic re-examination to maintain their board certification.

To verify my (or any other psychiatrist’s) certification status, you can use the website of the American Board of Psychiatry and Neurology (ABPN) who handles the board certification of psychiatrists.  The link to perform a search is https://application.abpn.com/verifycert/verifyCert.asp

You may be surprised to learn that a psychiatrist can advertise as a “child psychiatrist” without having ever had any specialized training in treating children.

A dual board certified child, adolescent, and adult psychiatrist has two board certifications; one in general psychiatry and one in child & adolescent psychiatry.  To be eligible for both board certification examinations, one must complete both a general psychiatry residency, and then a two-year fellowship specific to child & adolescent psychiatry.  After completing this training, two separate certification examinations are taken.  Additionally, ongoing re-examination must occur to retain board certification, and continuing medical education is required to be eligible for re-examination.

The complete training schedule for a board certified child & adolescent psychiatrist is effectively, four years of undergraduate education, four years of medical school, one year of internship (training rotations involving internal medicine, pediatrics, and neurology), two to three years of general psychiatric residency, and two years of child & adolescent psychiatry fellowship.

A dual board certified child, adolescent, and adult psychiatrist offers a unique perspective and is trained to understand the importance of how a patient’s childhood and development affects them throughout their lifetime.