Anthony M. Kassir, M.D., A Professional Medical Corporation  
     
     
Insurance

Most of my patients use their insurance to see me and are able to afford the fees with the help of insurance.

 

How this works

When you see Dr. Kassir, he asks for payment in full at the time of the meeting, as cash or personal check. He will give you a special kind of receipt for your payment. You may then submit this receipt to your insurance company, usually with a claim form. Your insurance company will send you reimbursement directly.

 

Generally speaking, PPO plans will reimburse a portion of the fees, while other types of insurance (such as HMO or EPO plans) do not reimburse for services provided by out-of-network physicians. The amount of reimbursement depends on your specific insurance plan and who provides it. Most plans pay about half the fees. More infrequently, a plan may pay more (e.g. 100%) or less (e.g. 25%). You may have to meet a deductible before you receive payment. 

 

Why Dr. Kassir is an out-of-network physician

In summary, my decision to be an out-of-network provider helps you get well faster, save time, use less medication, and have fewer professionals involved.

I have chosen not to accept insurance because I want to deliver the highest quality of care tailored to your specific needs, without an insurance company influencing the time I can dedicate to your care or the type of treatments I can provide. Insurance companies tend to limit the time and types of treatment that can be provided by a doctor by applying financial incentives to doctors to see as many patients as possible, and to end treatment quickly. This often results in abbreviated sessions for each patient, and might result in ending treatment before you feel ready.

Since I don’t work with insurance companies, I am free from this kind of influence and take the time to provide integrated treatment. Integrated treatment means I am free to combine “talk therapy” (psycho-therapy) with medical evaluation (and medicine, if necessary) in the same session. This saves you time because you see only one professional instead of two. Also, you will have the opportunity to receive my psychotherapeutic services, benefiting from my expertise and special training in psychotherapy.

Integrated treatment is usually more rapid and effective in solving problems and, if medication is needed, it may lead to less medication being necessary. This is because we are treating the problem from several directions (psychotherapy and medication) instead of just one (medication). Furthermore, I am able to take the time necessary to listen and understand all contributions to your problem, whether they are biological, medical, psychological, environmental, or social. This is essential when you want to solve the root of the problem, and not apply just a temporary or incomplete solution. Not infrequently, psychotherapy is enough, and we can treat the problem without medication at all.

The decision about when treatment is complete is up to you. You know when you feel better. Your insurance company cannot pressure us to end treatment before you feel ready since I have no obligation to them. My obligation is entirely to you.


Finally, I believe you should always be able to control whether, when, and to whom you will release your own private medical information. When your doctor takes insurance (or if you send receipts to your insurance to seek reimbursement) your medical information such as your diagnosis and the procedures performed are sent to your insurance company. In some cases, your insurance company is allowed to share this private information with other parties. This may affect your ability to buy individual disability or life insurance coverage later. These concerns notwithstanding, often using insurance is more economical and is frequently necessary.

 

Fortunately, the Affordable Care Act (ACA) requires healthcare insurance companies to cover pre-existing conditions. If and when the ACA is repealed, the new law may or may not require coverage for pre-existing conditions, but time will tell.


   


No Insurance?
How to get insurance under the Affordable Care Act (while it lasts)

The Affordable Care Act (also known as ObamaCare) is Federal legislation that requires everyone to have health insurance or pay a penalty. You can't be denied insurance due to a pre-existing condition, and virtually all mental health diagnoses will be covered. Note that the ACA might be repealed and replaced, and the new American Health Care Act may remove or modify these benefits.

in the meantime, as part of the ACA, states like California have set up their own "exchanges" where people can shop for insurance and compare plans. For more information, visit California's marketplace.

Since I have chosen not to accept insurance for the reasons explained above, those individuals wishing to receive reimbursement for my services from their insurance must choose a PPO insurance plan. PPO plans will cover my fees at the rate for out-of-network providers, while other types of plans like HMO and EPO plans appear not to cover out-of-network providers at all. This is true whether or not you buy your insurance through the California exchange.

Those individuals using the California marketplace to buy insurance will have several different levels of coverage to choose from. These levels are called platinum, gold, silver, and bronze. Each level or tier has different benefits and costs. As I understand it, if you would like to be reimbursed for my services, it doesn't seem to matter which tier you choose as long as you select a PPO plan. (This information has already changed once and may change again; please check the Covered California website for the most up-to-date information.)


  
Mental Health Parity

In the past decade, there have been several Federal and State legislative advances requiring insurance companies to provide coverage for mental illnesses and substance abuse that is at parity with (equal to) coverage for medical illnesses.

For example, your insurance plan may be required to reimburse you for mental health treatment at the same rate that it would reimburse you for medical illnesses like diabetes or high blood pressure. Insurance companies may have to use the same co-pays, deductibles, or out-of-pocket limits for mental health treatment, compared to medical and surgical treatment.

As several Federal and State laws supporting parity have been passed, enforcement is now paramount. Insurance companies do not always appear to honor parity requirements. The American Psychiatric Association, California Psychiatric Association, and the local district branch of the APA, the Orange County Psychiatric Society, continue efforts to support meaningful parity legislation and enforcement of new and existing rules.

Patients who know their rights under the parity legislation are better equipped to protect their rights. In March 2017, the American Psychiatric Assocation updated its "Parity Poster" entitled "Fair Insurance Coverage: It's the Law." Written for lay people, the poster clearly describes your rights under the parity laws and the steps to take if you think your rights are being violated.

Legislation supporting mental health parity and other important provisions include the Mental Health Parity Act of 1996, signed into law by President Clinton; California's Mental Health Parity Bill of 1999 (effective 2000); the Wellstone Domenici Federal Parity Law of 2008; the Patient Protection and Affordable Care Act (PPACA) of 2010, and the 21st Century Cures Act, signed by President Obama in December 2016.