Authorization

 

DAVID C. HALL, Ph.D.
Clinical Psychologist

715 E. Grand Blvd.
Corona, California 92879

800 660 7757
Fax: 775 248 9159

PSYCH CONSULT - EXTRAORDINARY SERVICE

 

WE WILL NOT SEE THE PATIENT WITHOUT THIS AUTHORIZATION

This patient has been scheduled for psych evaluation as authorized by you. We are tentatively holding an appointment time for this patient. We will not confirm the appointment until receipt of this pre authorization so it is very clear what services we will be providing. If it is not received 72 hours prior to the appointment, it will be canceled. We are NOT requesting that the FEES be pre authorized, only the level of service. FEES will be determined by bill review, of course, except for the no show fee where they will pay nothing and we are losing 4-5 hours of doctor time. The NO SHOW fee of $350 MUST be pre authorized. The $350 does not come close to covering the loss to the office if the patient fails to appear.

The visit will take approximately 2 hours face to face plus 2-3 hours of psych testing which will be billed as 99355. 99205 will be billed for the first 80 minutes face to face and 99354 for any additional face to face time. 99355 or 99356 will be billed for review of any records you send for Dr. Hall to review. In addition, it is impossible to adequately address all psych issues appropriately in a 6 page report which is all bill review will pay without your specific pre authorization. This will confirm payment for ALL pages required for this and all subsequent requested reports (including MMI), at fee schedule PER PAGE 5 OF THE OMFS which is 6.5 rv for first page and 4.0 rv for each additional page.


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