Payment Information
Insurance & Fees
Unlike many psychiatry practices, we accept insurance. We're in-network with most major carriers, making quality mental health and addiction treatment accessible.
In-Network Insurance
We are in-network providers with the following insurance companies. If you have one of these plans, your visits will be covered at in-network rates (subject to your specific plan's copay, coinsurance, and deductible).
- Blue Cross Blue Shield (most plans)
- Horizon Blue Cross Blue Shield of NJ
- Aetna
- United Healthcare*
- Carelon Behavioral Health
- Oscar Health
- Anthem / Empire Blue Cross Blue Shield
- TRICARE
- Humana
- Health Net
* United Healthcare participation is through a third-party network. We'll verify your specific coverage when you call.
High-deductible plan? If you have a high-deductible insurance plan, we can refer you to Headway, which has special arrangements with many insurance plans that may reduce your out-of-pocket costs.
Not sure if we take your insurance? Call us at (732) 530-3122 and we'll verify your coverage. Insurance networks change, and we may accept plans not listed here.
Verifying Your Insurance Coverage
Before your first appointment, we'll verify your insurance benefits. To help us do this, please have the following information ready when you call:
- Insurance company name — e.g., Blue Cross Blue Shield
- Plan name — Often shown on your card (e.g., "PPO," "HMO," "EPO")
- Member ID number — The unique number that identifies you
- Group number — If you have employer-sponsored insurance
- Phone number on the back of your card — For the member services line
What We'll Tell You
After verifying your benefits, we'll let you know:
- Whether we're in-network with your specific plan
- Your copay amount (what you pay per visit)
- Your deductible (if applicable) and how much you've met
- Any coinsurance (percentage you pay after deductible)
- Whether prior authorization is required
You Can Also Call Your Insurance Directly
If you want to verify coverage yourself, call the member services number on your card and ask:
- Is Dr. Abir Marcus (NPI: ask us for this) in-network for my plan?
- What is my copay for outpatient psychiatry visits?
- Do I have a deductible for mental health services? How much have I met?
- Do I need prior authorization for psychiatric treatment?
- Are there limits on the number of visits per year?
Out-of-Network Coverage
If we're not in-network with your insurance plan, you may still have out-of-network benefits that can reimburse you for part of the cost. Here's how it works:
How Out-of-Network Reimbursement Works
- You pay us directly for each visit at the time of service
- We provide a superbill — a detailed receipt with all the codes and information your insurance needs
- You submit the superbill to your insurance company
- Your insurance reimburses you according to your out-of-network benefits
Questions to Ask Your Insurance
To understand your out-of-network benefits, call your insurance and ask:
- Do I have out-of-network mental health benefits?
- What is my out-of-network deductible? How much have I met?
- What percentage of "usual and customary" charges do you reimburse?
- Is there a maximum benefit amount per year?
- How do I submit claims for reimbursement?
Out-of-network reimbursement varies widely. Some plans cover 60-80% of the "allowed amount" after deductible; others provide minimal coverage. We're happy to help you understand your options.
Fees
For patients paying out-of-pocket (self-pay) or with out-of-network insurance:
| Service | Fee |
|---|---|
| Standard Visit | $255 |
This fee applies to most appointments including initial evaluations and follow-up visits. Some services may have different fees, which we'll discuss before scheduling.
Credit card processing fee: Credit card payments include a 3% processing fee. To avoid this fee, you can pay by cash, check, Venmo, or Zelle.
Payment Methods
We accept the following forms of payment:
- Cash
- Check — Made payable to "Abir Marcus MD LLC" (established patients only—we do not accept checks from first-time patients)
- Credit Cards — Visa, Mastercard, American Express (3% processing fee applies)
- HSA/FSA Cards — Health Savings and Flexible Spending Accounts
- Venmo
- Zelle
When Payment Is Due
Payment is due at the time of service. For insured patients, this means your copay or coinsurance. For self-pay patients, the full fee is due at each visit.
Financial Policies
Insurance Billing
We bill your insurance directly for covered services. You are responsible for your copay, coinsurance, and any deductible amounts. If insurance denies a claim, you are responsible for the balance.
Copays and Deductibles
Copays are collected at the time of service. If you have a deductible, you'll pay the full fee until your deductible is met, then your copay or coinsurance applies.
Balances
If you have an outstanding balance (from insurance adjustments, for example), we'll notify you and expect payment before your next appointment.
No-Show and Late Cancellation Policy
Appointments cancelled with less than 48 hours notice, or appointments missed without cancellation, are charged the full fee of the visit. This is not covered by insurance. Please note that prescription refills will not be provided if an appointment is missed.
Good Faith Estimate
You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Under the No Surprises Act, healthcare providers must give patients who don't have insurance or who are not using insurance an estimate of the expected charges for medical services. You can ask for a Good Faith Estimate before you schedule a service, or at any time during treatment.
Questions About Insurance or Fees?
We know insurance can be confusing. Call us at (732) 530-3122 and we'll help you understand your coverage and costs before your first appointment.