FAQ - Michael Swetye, M.D., P.C.

Frequently Asked Questions

What is your location, availability, and contact information?

See the section Contact & Portal for details.

What are your fees?

After reviewing the information below regarding insurance and reimbursement, please call me to discuss my fees.

What is the patient portal?

See the section Contact & Portal and scroll to the bottom for information about the patient portal. All my patients are given access to the portal.

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What is the difference between a psychiatrist and other mental health professionals?

Psychiatrists are physicians with general medicine training as well as specialty training in mental health issues. One advantage of seeing a psychiatrist at least for the initial assessment is that we are trained holistically, that is to notice the biological, neurological and medical issues as well as psychological and social issues that can contribute to any given problem. We "cover all the bases," so to speak. Additionally, we have the legal authority to prescribe medication and monitor its effects. We often collaborate with other mental health professionals in a variety of ways.

What defines a child and adolescent psychiatrist?

The American Academy of Child and Adolescent Psychiatry defines a child and adolescent psychiatrist as a physician who specializes in the diagnosis and the treatment of disorders of thinking, feeling and/or behavior affecting children, adolescents, and their families. A child and adolescent psychiatrist offers families the advantages of a medical education, the medical traditions of professional ethics, and medical responsibility for providing comprehensive care. Child and adolescent psychiatric training requires 4 years of medical school, at least 3 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of additional specialized training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry. For further information have a look at the AACAP website here.

How do I select a psychiatrist or therapist?

I'm often asked this question by patients, friends and acquaintances. A referral by someone who was themselves helped by the therapist, or whom you really trust, is often a good sign. You also want to verify that the therapist has good credentials and training. Sometimes a brief phone conversation can help you to see if it's a good fit. During your first meeting, see if you like the therapist and if they seem professional, friendly, empathic, and curious. Finally, it's OK to consider looking elsewhere if you don't have a good feeling about the therapist at your first meeting. If you are considering leaving a therapist after you have had several successful meetings, I suggest first talking to the therapist about your concern.

What is your cancellation and no-show policy?

Once we schedule your time, I hold it specifically for you. As a courtesy to those who are on the wait list, please call me at least two business days before to cancel. For example, if your appointment is on Monday at 4pm, please call me no later than the previous Thursday at 4pm to cancel. If you do not give two business days notice, you will be responsible for the full session fee. Unfortunately, no insurance company reimburses for this. Emergencies are handled on a case-by-case basis.

Why should I use an out-of-network provider?

Quality: You/your child are free to get the best clinical care possible, without any interference from the insurance company.
Access: Appointments can last as long as they need to and can be as frequent as necessary.
Convenience: You can book appointments online, send secure emails, update your e-prescribe preferences, see real-time billing info and more from the patient portal.
Privacy: If you do not seek reimbursement from your insurance company, your/your child’s chart is completely confidential and will not be released without your permission. If you do seek reimbursement, confidentiality is still protected by HIPAA with limited release of information to 3rd party payers.
Financial: Many who do choose to seek reimbursement are surprised to find that the process is relatively simple and the benefits higher than assumed.

Do you accept insurance?

Not directly, though you may be eligible for out-of-network reimbursement. For insurance that covers out-of-network providers, patients are often able to obtain reimbursement for a majority of my fee. If you would like to use your out-of-network benefits and want further details before meeting with me, you may wish to call your insurance company and ask them the questions below. You will need to have my Federal Tax ID and fee available when you call, so please call me for that information. Once you have the information from you insurance company, I'd be happy to discuss with you what it might mean about your treatment costs. Please note that if you are told I am in-network, that is incorrect.

How much does my plan cover for an out-of-network provider?
What is my out-of-network deductible and has it been met?
What is my out-of-network annual out-of-pocket cap?
Do I have to have a “parity” (i.e. severe) diagnosis, to qualify for benefits?
How many sessions per calendar year does my plan cover for a parity, or non-parity, diagnosis?
What is the maximum coverage amount (sometimes called the “UCR,” or “usual and customary rate”) for procedure codes listed here in bold
Is approval or a referral required from my primary care physician?
Do I need to obtain pre-authorization?
Are my benefits on a calendar year basis, or a plan year? If on a plan year, when does it start?

How do I get reimbursed by my insurance company?

Once you have paid your balance in full, you simply submit your receipt (which shows all necessary diagnostic and procedure codes and that you have paid) along with your insurance company’s claim form (typically found on their website), either by fax or mail, and your insurance company reimburses you directly. Insurance companies will not accept claims for dates that have not been paid.

The amount the insurance company sends you, once you meet your out-of-network deductible and assuming you have obtained any necessary prior authorizations, is based on the percentage of out-of-network coverage your plan authorizes (typically 50-80%) of the allowable rate, which varies based on plan. Please note insurance plans typically do not cover time spent in care that is conducted between sessions.

I will be happy to help you estimate what your actual total cost will be once you call your insurance company and get the information above, and to give you any guidance I can in the process.

For information about mental health parity (i.e. metal health conditions being covered by insurers at parity with physical health conditions) go here.

Do you accept Health Savings Account, Flexible Savings Account, or Health Reimbursement Account (HSA/FSA/HRA) debit cards?

Yes. If you have a pre-tax account set aside for healthcare expenses, you may pay by check and submit your receipt to that account for reimbursement. If you do not have one, ask your human resources department if you can set one up.

Do you share phone call information with third parties?

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. Text messaging originator opt-in data and consent information will not be shared with any third parties.