FAQ’s About Your Mental/Behavioral
Health Benefits

What services are covered by insurance?

Insurance coverage is between the member (you) and the insurance company. It is recommended that when you schedule an appointment for your child with our office, you also contact your health insurance company to inquire about mental/behavioral health benefits. You should ask what services are covered and the extent of your financial responsibilities. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Insurance companies also will only pay for services that they determine to be medically necessary. Educational or forensic services are typically not medically necessary.

Do I need to contact my health insurance company or will Tashawna K. Duncan, Ph.D., P.A. do that for me?

Again, it is recommended that you contact your own insurance company. However, we will typically call your insurance company to obtain benefit information and share the results with you. This does not mean that we are guaranteeing that your insurance company will pay. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service, even if they tell us wrong information over the phone.

Why are my behavioral health benefits different than my medical benefits?

It is not unusual for your mental/behavioral health benefits to be managed by a different company than your medical benefits. Additionally, medical and mental/behavioral health benefits with the same insurance company may differ significantly. For example, you may have two different deductibles.

What happens if Tashawna K. Duncan, Ph.D., P.A. is not considered in-network for my insurance plan?

For health insurance plans for which we are not considered in-network, full payment at the time of service will be required. We will be happy to provide you with a statement, which you can submit to your insurance company for reimbursement.

What does it mean if Tashawna K. Duncan, Ph.D., P.A. is considered an in-network provider?

For some insurances, Tashawna K. Duncan, Ph.D., P.A. has entered into a provider agreement with the insurance company to be considered a network provider. This typically means that the reimbursement rate for services provided to network participants is established in a written contract with the insurance company. However, in some cases, Tashawna K. Duncan, Ph.D., P.A. may be listed as in-network for some services but may not have an in-network negotiated rate for other services. The obligations of Tashawna K. Duncan, Ph.D., P.A. is specified in the provider agreement and the Agreement for Professional Services with you. Your obligation to Tashawna K. Duncan, Ph.D., P.A. is specified in the Agreement for Professional Services, regardless of the existence of any insurance coverage. Your insurance company has no authority to make promises on behalf of Tashawna K. Duncan, Ph.D., P.A. or to bind Tashawna K. Duncan, Ph.D., P.A. to perform any service to you. You, as the patient, must pay careful attention to the contracts you have with your insurance company and your provider so that you understand your obligations.