Forms
Reclaim Joy Medical strives to be as paperless as possible. A new patient fills out the below routine new patient forms (referred to in emails as “Questionnaires”) through the online Patient Portal. Copies of the policies and agreements are here for reference, and the copies electronically signed by the patient are also available on the Patient Portal.
- HIPAA Policies
- Dr. Freerksen’s Out of Network Policies and Procedures
- Controlled Substance Agreement
Not part of the new patient package, but still helpful is the Release of Treatment Information Form, as referenced in Reclaim Joy Medical’s HIPAA Policies.
Insurance – Out of Network Provider (OON)
Reclaim Joy Medical is an out-of-network provider with all private insurances. All services provided are self-pay, and fees are due on the date of the session. We do not participate with any insurance plans, except for our established patients who age into Medicare. We will provide you with an insurance-compatible billing statement (Superbill) for you to submit to your insurer for reimbursement for out-of-network providers. Please contact your insurance provider to verify how your plan compensates you for mental health services.
We’d recommend asking these questions to your insurance provider to help determine your benefits:
- Does my health insurance plan include out of network mental health benefits?
- Do I have a deductible? If so, what is it and have I met it yet?
- Does my plan limit how many sessions per calendar year I can have? If so, what is the limit?
- Do I need written approval from my primary care physician in order for services to be covered?
Medicare – Not Participating
Reclaim Joy Medical is not currently accepting new Medicare patients at this time. We do have patients who have aged into Medicare, but Dr. Suzanna Freerksen is currently a Not Participating Provider with Medicare, and is not accepting new Medicare patients at this time.
Mysourcewise.com has resources for those with Medicare. You can also search for a provider who accepts Medicare by using the search filters for insurance on Psychology Today (psychologytoday.com).
Medi-Cal – Out of Network Only
Reclaim Joy Medical is an out-of-network provider and does not bill Medi-Cal. Professional fee is due on the date of service by credit card. We do treat Medi-Cal recipients, however these patients pay out-of-pocket because Medi-Cal will not reimburse for Reclaim Joy’s services. The Medi-Cal recipients we see usually have financial assistance from family members.
If you are looking for a Medi-Cal mental health provider and are in Santa Clara County, call: 800-704-0900. If you are Looking for a Medi-Cal mental health provider in Alameda County, call: 800-491-9099. If you are looking for a Medi-Cal mental health provider in Los Angeles County, call: 800-854-7771.
Reclaim Joy Medical Complies with the No Surprises Act
Under the No Surprises Act, health care providers need to give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service, or at any time during treatment.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, or how to dispute a bill, see your Estimate, or visit www.cms.gov/nosurprises.
Centers for Medicare and Medicaid Services (CMS) Open Payments Database
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.
The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.