Insurance & billing
Paying for care, explained plainly.
Camellia Wellness is a Medicare Non-Participating Provider. Here is exactly how billing and reimbursement work.Camellia Wellness is a Non-Participating Provider within the Medicare system. Here's exactly how that affects your financial responsibilities and your potential for reimbursement, with no jargon left unexplained.
Understanding “Non-Participating” StatusUnderstanding “Non-Participating” Status
Camellia Wellness maintains a status as a Non-Participating Provider within the Medicare system. Since Medicare regulations can be complex, please review the following details regarding how this designation affects your financial responsibilities and potential for reimbursement.
While I continue to serve Medicare beneficiaries, being “Non-Participating” means my private practice does not accept “assignment” (direct insurance payment). Instead, the following guidelines apply:
- Point-of-Service Payment: Patients are responsible for the full cost of psychiatric care at the time each service is rendered.
- The Limiting Charge: For your protection, federal regulations cap my fees. I cannot exceed the “Medicare Limiting Charge,” which is set at 115% of the approved non-participating schedule.
- Administrative Support: To simplify the process, my office handles all required paperwork. We will submit medical claims directly to Medicare so you can receive any reimbursement owed to you.
How You Get Reimbursed
Because I submit the claim on your behalf, you do not need to mail in a superbill. The process flows automatically:Because I submit the claim on your behalf, you do not need to mail in a superbill. The reimbursement process flows automatically through the federal system:
01
Pay at Session
You pay the practice the Medicare-limited fee at the conclusion of your visit.
02
We File the Claim
My billing system automatically transmits a standard CMS-1500 insurance claim to Noridian (Washington State's Medicare contractor).
03
Medicare Pays You
Medicare processes the claim. Once your annual Medicare Part B deductible is met, Medicare will mail a reimbursement check directly to your home (or deposit it into your linked bank account) for their covered portion of the visit—usually 80% of the approved amount.
Self-pay fees & billing codes
The CPT codes on your superbill — the same codes as Medicare, only the fee differs.These CPT codes appear on your superbill and are the same codes used for Medicare — only the fee differs. They are worth quoting when you call to check your benefits.
| Code | Service | Duration | Fee |
|---|---|---|---|
| 99205 | Initial Psychiatric Evaluation | 60–75 min | $300.00 |
| 99214 | Follow-Up & Medication Management | 45 min | $175.00 |
| 90833 | Psychotherapy add-on | 30 min | $75.00 |
99205 · $300.00
Initial Psychiatric Evaluation · 60–75 min
99214 · $175.00
Follow-Up & Medication Management · 45 min
90833 · $75.00
Psychotherapy add-on · 30 min
Medicare
Important Checklist Before Your First Visit: If you are a Medicare beneficiary planning to schedule an appointment, please review the following:
Secondary/Medigap Insurance: If you have a supplemental insurance plan, Medicare will automatically forward the processed claim to them after paying their portion, which may cover your remaining out-of-pocket balance.
Medicare Advantage (Part C): If you are enrolled in a private Medicare Advantage plan (e.g., through UnitedHealthcare, Humana, or Kaiser), out-of-network rules vary. Please call your specific plan coordinator to ask how they handle “out-of-network, non-participating providers.”
Prescriptions & Labs: Your pharmacy and laboratory benefits remain unaffected. Any medications I prescribe or blood work I order will still be processed normally by your Medicare Part D or Part B benefits.
| CPT Code & Service | Fee |
|---|---|
| 99205 (Initial Evaluation, ~60-74 min) | $200.00 |
| 99214 (Moderate Complexity Follow-Up, ~30 min) | $125.00 |
| 90833 (Psychotherapy Add-on, 30 min) | $70.00 |
99205 (Initial Evaluation, ~60-74 min)
$200.00
99214 (Moderate Complexity Follow-Up, ~30 min)
$125.00
90833 (Psychotherapy Add-on, 30 min)
$70.00
Still have questions about cost?
No question about money is unwelcome here.Ask before you book — there's no obligation, and no question about money is unwelcome here.