Bright Horizons Psychiatry is in network with Aetna, Blue Cross Blue Shield, Cigna, Tricare, UnitedHealthcare, Johns Hopkins EHP, Medicare and Maryland Medicaid. You do not need a referral to book with us.
We verify your benefits before your first visit
Our staff files prior authorizations for Deep TMS and Spravato
No referral needed to schedule
Two Maryland offices, Rockville and Frederick
Both of our Maryland offices bill the same plans. Coverage is the same whether you are seen in Rockville, in Frederick, or by telehealth as an established patient.
Commercial and Medicare Advantage
Including CareFirst plans
Commercial and behavioral health
Military and family coverage
Including Optum behavioral
Employer health programs
Part B outpatient psychiatry
State plan coverage
Plans change their networks, and a single carrier can run dozens of products with different rules. Before your first visit we run your specific plan and member ID so you know what your coverage looks like rather than what it should look like. If you do not see your plan above, call us anyway. We may still be able to help.
Most people call a psychiatry office and get told to check with their insurer. We do that part for you, and we do it before you sit down with a provider.
Carrier name, member ID and group number, either on the phone or through the booking form. It takes about two minutes.
Our staff checks that we are in network under your specific product, and confirms what your plan requires for the visit type you are booking.
Before your appointment, not after it. If something in your plan would create a surprise, you hear about it from us first.
Prior authorization is where most people give up on advanced depression treatment. Insurers want documentation of prior medication trials, current symptom severity scores, and a clinical rationale, submitted in the format that carrier expects. That paperwork is our job, not yours.
Dr. Etesam and our clinical staff build the authorization packet from your record, submit it, track it, and appeal it if the first submission comes back denied. Denials on first submission are common across the industry and are frequently overturned on appeal.
Coverage rules differ by treatment and by plan. Here is how each of our services generally works, and what we confirm for you before you begin.
Initial evaluations and follow up medication visits are billed as standard outpatient psychiatry under all of the plans listed above. Your responsibility is whatever your plan sets for a specialist visit.
Deep TMS is covered by Medicare and by most commercial plans for treatment resistant depression, once you meet that plan's criteria. Nearly every carrier requires prior authorization first. We assemble and submit that request.
Read our full guide to TMS insurance coverage in MarylandSpravato is an FDA approved treatment and is covered by many plans for treatment resistant depression. It carries its own authorization requirements, and it must be given in a certified REMS setting, which our office is. We verify both before scheduling your first session.
Coverage for intramuscular ketamine depends heavily on the plan. We check your specific benefits and tell you exactly what your plan will and will not pay for before you commit to a course.
Established patients can be seen by telehealth for follow up care. These visits are billed to the same plans listed above. We confirm your plan's telehealth rules when we verify your benefits.
You do not have to work that out before you call. Start with an evaluation, and coverage questions get answered as part of building your treatment plan.
Book an evaluationBeing out of network does not mean you have no coverage. Many plans reimburse a share of what you pay an out of network psychiatrist, and getting that money back is mostly a paperwork question.
You pay at the time of service. We then give you an itemized superbill with the diagnosis codes, procedure codes, our NPI and tax ID, and everything else your carrier asks for.
You submit that superbill to your plan, and any out of network reimbursement your policy allows comes back to you directly from your insurer.
Call the member services number on your card and ask three things.
Those answers tell you what an out of network visit actually costs you, and our front desk can walk you through what you hear back.
Having these on hand lets us verify your benefits on the first call instead of the third.
No. You can book directly with us. A few plan types, mainly HMO products, ask their members to get a referral from a primary care physician before seeing a specialist. We check that when we verify your benefits and tell you if your plan requires one.
Yes, both. Medicare Part B covers outpatient psychiatric care, and we accept Maryland Medicaid at our Rockville and Frederick offices. Medicare also covers TMS for depression when the medical necessity criteria are met.
Most major plans and Medicare cover TMS for treatment resistant depression, but every plan sets its own bar. The common requirements are a diagnosis of moderate to severe major depressive disorder and documentation that you tried and did not respond to a set number of antidepressants in the current episode. Some plans also want evidence you tried psychotherapy. We review your history against your plan's criteria before we submit anything.
It depends on the carrier. Some turn around a decision in a few business days, others take longer, and some come back with a denial that we appeal. We submit as soon as your evaluation gives us what the plan needs, and we keep you updated on where the request stands.
A first pass denial is not the end of it. We file an appeal with additional clinical documentation, and appeals frequently succeed where the initial request did not. If a treatment stays uncovered after appeal, we talk through the alternatives with you rather than leaving you to figure it out.
Telehealth follow up visits for established patients are billed to the same plans we accept in the office. Plans differ on their specific telehealth rules, so we confirm yours during benefits verification.
Yes. Both Maryland locations bill the same plans, so you can be seen at either office without a change to your coverage.
Call us. Carriers run many products under one brand name, so your plan may still work even if the exact name is not listed. If we are genuinely out of network, you can still be seen and we will provide an itemized superbill you can submit to your plan for out of network reimbursement.
