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Rates & Insurance


Insurance

Presently, Dr. Simon is in-network with Aetna, Anthem Blue Cross, Cigna, Connecticut Husky/Medicaid, Medicare, and United Healthcare. For Aetna, Anthem, Cigna, Medicare, and United Healthcare patients a co-pay may be required for each visit. If you have health insurance other than Aetna, Anthem, Cigna, Connecticut Husky/Medicaid, Medicare, or United Healthcare then you must contact your insurance company to inquire whether they pay for out-of-network providers. We will assist you in contacting your insurance company to see if they will pay for some or all of our fees. To allow us to do this, please complete the following form and fax it to Dr. Simon's office at 1-860-786-1192:

Insurance information form

If your insurance company does not agree to pay for services, then you may pay at the time of each visit and you will be provided with a 'super bill' to submit to your insurance company for reimbursement of the money you paid. Because of recently enacted laws requiring payment for mental health and addictive disorders, many insurance companies will reimburse some of the money paid by the patient. However, this would be between you and your insurance company, and no guarantee of reimbursement or payment from an insurance is implied here. It is advised that you ask your insurance company about this before hand.

Generally, most (if not all) insurance plans will pay for the cost of prescribed buprenorphine (Suboxone/Zubsolv/Bunavail) obtained at a pharmacy minus any required co-pay. In addition most insurance companies will pay for the costs of laboratory tests such as urine toxicology to check for compliance with prescribed therapy and to rule out illicit drug use. However, some payers may have a limit as to how many urine drug tests they pay for. Since drug testing is mandatory while being prescribed buprenorphine, patients are advised to check with their insurance companies about this. Connecticut Husky/Medicaid, however, has paid for these services in the past without limitation. Nevertheless, no guarantee of payment by any insurance company is implied here.


Fee for Service Rates


Fees for service charged to patients as of January 2015 are as follows:

Initial consultation & evaluation, which generally lasts about 60-75 minutes is $250. For medication assisted treated ("MAT") for opioid use disorder a second visit for 'buprenorphine induction' is required, which costs $200. Subsequent visits for medication management and brief counseling, generally lasting 20-30 minutes, are $120 per visit. Discounts are available for full payment at the beginning of each month.

For new buprenorphine (Suboxone/Zubsolv) patients, weekly visits are required until stabilization at no greater than a certain dose of buprenorphine . Therefore, total fees for the first month will be $250 + $200 + $120 + $120 + $120 = $810. For the second month of buprenorphine therapy and thereafter until stabilization at no greater than a certain dose of buprenorphine, weekly visits are required ($120 x 4 totalling approximately $480 per month). After stabilization visits may be decreased to three times per month, and then to every other week (twice a month). Patients must continue visits every other week as long as buprenorphine is prescribed.


For patients not covered by Aetna, Anthem, Cigna, CT Medicaid/Husky, Medicare, or United Healthcare, full payment is required at each visit in the form of cash, credit card, or PayPal. Those non-covered persons may agree to pay at the beginning of each month for the month's services at a discounted fee. If you pay for the first month up front the fee is discounted from $810 to $700. If you pay for subsequent monthly visits at the beginning of each monthly cycle the fee is discounted from $480 to $400.

All co-pays for patients covered by Medicare and 'private' insurance companies are due at time of service.

Forms of Payment Accepted.

Cash, credit card, and PayPal payments are accepted before or at the time of service.


Cancellation Policy

Except for a documented, legitimate emergency, if you do not show up for your scheduled therapy appointment, and you have not notified us at least 24 hours in advance, you may be required to pay for the cost of the missed session. Patients are prescribed future doses of medication at each scheduled appointment.


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