Appointments, billing, insurance, credit card on file policy, downloadable documents and forms
Scheduling Your Appointment
Thank you for visiting our website. Our office is open Monday-Saturday. The office staff are generally available to answer phones Monday through Thursday from 9am-3pm and Fridays from 9am-12pm. Therapists work a variety of hours, with some evening and Saturday appointments available. The Testing Clinic is primarily scheduled on weekdays.
Phone calls and other contact methods are handled by our administrative assistants.
Please specify if you are calling for therapy, testing, or psychiatry so you can be routed the the correct department. For better understanding, psychiatry is medication management &/or prescriptions; therapy is speaking directly with a licensed counselor to alleviate symptoms, various issues, etc.; while testing is for evaluating and assessing diagnostic criteria (ADD, executive functioning, autism, etc.) &/or educational needs (i.e. reading, writing, math comprehension)
Therapy/Counseling: We are currently not taking new clients for therapy services. When we are actively taking new clients, we will update this website with further information. After reviewing your needs, the office staff will add you to our general wait list. Once availability is open, our Intake Coordinator who will determine which one of the licensed clinicians would be best to accommodate your needs.
Psychiatry: Please call our office to schedule an intake appointment with our Psychiatrist, Dr. Zambenedetti (Dr.Z).
Testing Clinic: We currently have a 4 to 6 month wait list for our testing clinic services. Please see the “Testing Clinic” tab for more information.
If we are able to accommodate your needs we will contact you to schedule an appointment as soon as possible. If you call and receive our voicemail, please leave a brief message with the client’s name, date of birth, insurance company & general reasoning for call. We will return all calls within 2 business days depending on call volume.
Insurance & Billing/Payments
At the current time we accept:
Blue Cross Blue Shield of Rhode Island
Blue Cross Blue Shield Federal Employee Program
Blue Cross Blue Shield Out of State Plans (i.e. MA, SC, IL, etc.)
If you have questions on your specific Blue Cross Plan, you can check your insurance booklet or call your insurance carrier. If you have an OUT OF STATE blue cross plan, please check your coverage, as it often differs from state to state.
Tricare – Please be aware that Tricare sometimes require the subscriber’s SSN for providers to check a client’s benefits
United Healthcare, United Ritecare & UMR
Medicare – We accept this for Psychological & NeuroPsychological Testing. We also have ONE therapist that accepts Medicare as a third-party payer.
Some therapists, but NOT testing clinicians, accept Tufts Health Plans. If you have out of network coverage, a portion of the cost may be covered by your insurance.
If we do not take your insurance, we can offer a cash rate for our services.
For psychological and neuropsychological testing we accept the above mentioned insurance plans. If your insurance plan does not cover psychological or neuropsychological testing you may be responsible for out of pocket costs. There is also a mandatory testing materials fee that cannot be billed to your insurance. This covers the costs of the materials used for testing and is contingent on the client’s specific case. This fee is no more than $100 (average is about $65) and will be charged to your provided credit card once testing services are complete.
Please be aware of large deductibles that are common with some insurance plans, especially if they are an out of state plan. It is always helpful if you are aware of your own insurance coverage before coming in for an appointment. As a courtesy, we will check your insurance once you are an active client, however it is often difficult to obtain current and accurate information.
For any questions about fees, please contact our office by phone. All patients are expected to pay their copay and/or deductible (if applicable) at the time of the session. We also ask that a 24 hour notice for cancellation be provided if possible.
CREDIT CARD ON FILE POLICY
To make it convenient for patients to pay for services, we have a credit card on file policy. We can simply charge your card on file for each copay, deductible, or other service fees. Our electronic health record system allows the storage of card information in a PCI-DSS (Payment Card Industry Data Security Standard) compliant and HIPAA (Health Insurance Portability and Accountability Act) compliant manner which ensures an encrypted vault for your safety. This will expedite check in and check out times and cut back on mailing patient statements. All patients are required to provide a valid credit card to be held in our system. Please read the policy attached for specifics.
Excerpt from our Credit Card on File Policy:
“Recent shifts in the healthcare industry have resulted in insurance companies increasingly transferring costs to our patients, you, the insured. This is driving many practices to adopt new financial policies to enable more efficient operational processes. Some insurance plans require deductibles and co-payments in amounts not known to you or us at the time of your visit.
To streamline our billing and payment system and to provide a seamless, convenient way for patients to pay their bills, effective October 28, 2019, Karen Gieseke, PhD and Associates will require all patients keep an active credit card on file with us. We will bill your insurance company first and upon their determination of benefits, we will only charge your credit card when they inform us of patient responsibility. Circumstances when your card would be charged include but are not limited to missed or canceled sessions without 24-hour notice, co-payments, deductible and co-insurance, any non-covered services and/or denial of services.
Copays will continue to be due at the time of service. Once the insurance has paid their portion and notifies us of the balance due, we will charge any remaining balance owed by you to your credit card and a copy of the charge will be provided to you.
Forms
For reference, please download &/or complete the forms provided below.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that requires the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. This document is for review and does not need to be signed or completed.
The general referral form is for outside providers to fill out (if they do not have their own standardized sheet). This form can be completed by a Primary Care Physician (PCP), Mental Health professional, or appropriate School Official. Once this form is filled out, our office staff will call the client directly once availability arises.
An Educational Assessment is typically less comprehensive than a Neuropsychological &/or Psychological Assessment. Educational testing focuses primarily on ability (intellectual) and achievement (academic) testing. This type of testing is not considered medically necessary by insurance companies; therefore, would be the client’s responsibility for out of pocket expenses. Please see the Testing Clinic tab for more information. Once this form is filled out, our office staff will call the client directly to discuss and schedule educational testing.
The Release of Information (ROI) is for anyone you would like us to contact regarding this service. This could be your primary care, therapist/counselor, a family member or school official. It gives us permission to share information or contact this individual &/or office.
Completed forms can be faxed (401-842-0059) or scanned and emailed to the office at gieseke.assoc@gmail.com. Please be advised that email is not a secure method of communication for medical or other personally identifiable information.