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If Compsych is not your insurer, please contact your employer's HR or benefits department for assistance, and/or Sign Up through e-Psychiatry's main registration page at www.e-Psychiatry.com.
You have indicated that you are less than 18 years old. If this is an error, please correct your birthday on this form. If this is your correct age, then your legal guardian must complete the rest of this form. In addition, your legal guardian will be required to attend your first provider consultation or treatment session. Please have your guardian complete the rest of this form now.
The patient pays this full fee by payment card at the end of your session. The patient receives a payment receipt from e-Psychiatry they can use if they plan to seek reimbursement from an insurer. The patient has been advised that e-Psychiatry cannot guarantee insurer reimbursement, and that the patient should confirm this in advance of your session.
If you are a participating ("par") provider with this patient’s insurer, you may use the Initial Consult Fee shown above, or you may apply your own separate fee schedule with this insurer. If you intend to apply your separately contracted fee schedule with this insurer, please notify your patient in advance, and be sure to follow your contractual obligations with this insurer related to patient copays, coinsurance, and insurer claims submission. In rare instances, if the services you provide during your initial consult are inconsistent with a standard initial consult CPT code and fee, you may apply an alternative CPT code and associated fee if appropriate.
e-Psychiatry Admin Fee:
Stripe Financial Fee: Your Stripe account fee for processing the patient’s payment is approximately 3% of the fee that the patient pays to you on the date of service (there is no Stripe fee for the claim amount you submit to the insurer).
Fee Schedule for Follow Up Sessions: If you decide to continue treating this patient beyond your initial appointment, your fee schedule for this patient will be displayed to you at that time.
Reminder: Be sure to indicate your private practice fees in your Provider Profile.
Initial Consult
Initial Consult Fee:
Providers charge the patient a copay or coinsurance, and submit a claim to the payer for the rest of the fee. Please confirm the patient's copay or coinsurance and deductible in advance of your session by contacting the payer's Benefits Department (see below).
The patient has been advised in advance that e-Psychiatry cannot guarantee insurer reimbursement, and that the patient should confirm this in advance of your session.
If you are a participating (“par”) provider with this patient’s insurer, you may use the Initial Consult Fee shown above, or you may apply your own separate fee schedule with this insurer. If you intend to apply your separately contracted fee schedule with this insurer, please notify your patient in advance, and be sure to follow your contractual obligations with this insurer related to patient copays, coinsurance, and insurer claims submission. In rare instances, if the services you provide during your initial consult are inconsistent with a standard initial consult CPT code and fee, you may apply an alternative CPT code and associated fee if appropriate.
e-Psychiatry Admin Fee:
Stripe Financial Fee: Your Stripe account fee for processing the patient’s payment is approximately 3% of the fee that the patient pays to you on the date of service (there is no Stripe fee for the claim amount you submit to the insurer).
Fee Schedule for Follow Up Sessions: If you decide to continue treating this patient beyond your initial appointment, your fee schedule for this patient will be displayed to you at that time.
Reminder: Be sure to indicate your private practice fees in your Provider Profile.
