Here you will find information on how to contact us for billing inquiries, the insurance plans we work with, and our insurance company affiliations. For additional information on a specific insurance company, you may click on the company name below to reach their website (if available).

BILLING INQUIRIES

PCSD – Patient Business Services & Billing Inquiries:

PCSD Patient Business Services
P.O. Box 609001
San Diego, CA 92160
(619) 528-4600 Option 3

INSURANCE PLANS

PCSD gladly accepts most insurance plans and will complete billing to the patient’s insurance company. PCSD asks the patient to provide us with the information regarding their insurance, including insurance card copies, subscriber’s name, identification number, and group number, if applicable. The patient is required to pay their copayment or a minimum payment at the time of service to be applied to their deductible or cost-share until the insurance processes the claim.

  • PPO (Preferred Provider Organization) Plans: PCSD providers are preferred providers for many PPO networks and will accept the negotiated rate for services provided. The patient is required to pay any cost-shares and deductibles as defined by their insurance policy. Many PPO networks require prior authorization to access mental health services; therefore you may wish to contact your insurance for pre-authorization prior to scheduling an appointment.
  • HMO (Health Maintenance Organizations) Plans: PCSD providers are affiliated with many HMO networks through association with the patient’s primary care physician. A primary physician referral is sometimes required to access mental health services and the patient is required to pay a co-payment at the time of service.
  • Medicare: PCSD’s physicians, psychologists, and licensed clinical social workers are participating providers in the Medicare program. PCSD will file the patient’s Medicare claim, as well as Medicare Supplemental Insurance claims. The patient is responsible for any deductibles and share-of-cost portion of the service.

INSURANCE COMPANY AFFILIATIONS

PCSD clinicians are affiliated with many insurance companies, indemnity as well as PPO and HMO networks. It is recommended that patients call PCSD or their insurance company for a listing of provider panel status. Here is a partial listing of affiliated insurance companies:

No Surprises Act & Good Faith Estimates

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in network facility but are unexpectedly treated by an out-of-network provider

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:
  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. If you have questions, you may also contact PCSD’s Billing Department at 619-528-4600. 

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • 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, visit www.cms.gov/nosurprises or PCSD’s Billing Department at 619-528-4600. 

FREQUENTLY ASKED QUESTIONS (FAQ)

I received a bill for a visit to a PCSD clinician. If I have questions, whom may I contact?

You may contact the PCSD Billing Department at (619) 528-4600.  The billing department is available to assist you during regular business hours from 8:00 a.m. to 5:00 p.m., Monday through Friday.

Why is my co-payment different from what I pay my Primary Care Doctor?

Mental Health benefits are different than medical benefits and most insurance plans require a higher co-payment when mental health services are accessed.  PCSD will be happy to assist the patient in verifying their cost-share.

What will my insurance pay?

Insurance plans vary on the mental health benefits that are offered.  In addition to benefit limitations, many health plans require prior authorization for mental health services.  It is recommended that patients contact their insurance company for specific information regarding plan benefits and authorization procedures.

Why does Medicare pay my psychiatrist less than my other doctors?

Medicare co-insurance for outpatient mental health services is 50% of the Medicare allowable fee. Co-insurance for Hospital services is 20% of the Medicare allowable. Many Medicare Supplemental insurances cover the patient’s deductible and co-insurance.

How do I make a payment?

Please pay your bill online, bring your payment to any one of the PCSD office locations, or mail your payment to:

PCSD Business Services
P.O. Box 609001
San Diego, CA  92160

Who can answer my insurance questions?

You may contact PCSD’s Billing Department at (619) 528-4600. A Patient Representative will be available to answer any questions you may have.