FAQS
Frequently Asked Questions
Do you accept insurance?
No, unfortunately Dr. Lerma is not accepting insurance at this time.
If you have insurance coverage, you may be eligible for out-of-network reimbursement. Please note that if you call your insurance company and you are told that Dr. Lerma is in-network, that is incorrect. If you would like to request an out-of-network reimbursement benefit from your insurance company, please call your insurance company and ask them the following questions:
How much does my plan cover for an out-of-network provider?
What is my out-of-network deductible, and has it been met?
What is my out-of-network annual out-of-pocket cap?
Do I need to have a “parity” (i.e, severe) diagnosis to qualify for benefits?
How many sessions per calendar year does my plan cover for a parity, or non-parity, diagnosis?
What is the maximum coverage amount per appointment (sometimes called the “UCR,” or “usual and customary rate”)?
Is approval or a referral required from my primary care physician?
Do I need to obtain pre-authorization?
Are my benefits on a calendar year basis, or a plan year? If on a plan year, when does it start?
Are there any advantages to being seen out-of-network?
Quality: You/your child may get the best clinical care possible, without any interference from the insurance company.
Access: Appointments can last as long as they need to last, and can be as frequent as necessary (depending upon prior approval from Dr. Lerma)
Privacy: If you do not seek reimbursement from your insurance company, your/your child’s chart is completely confidential and will never be released without your permission.
Financial: Many who do choose to seek reimbursement are surprised to find that the process is relatively simple and the benefits higher than assumed.
How do I get reimbursed by my insurance company on an out-of-network basis?
Once you have paid your balance in full, you may simply submit a superbill (which shows all necessary diagnostic and procedural codes and that you have paid) along with your insurance company’s claim form (typically found on their website), either by fax or mail, and your insurance company may mail you a reimbursement check. Insurance companies will not accept claims for dates that have not been paid. Please note that superbills are available to patients, and parents/guardians, through the patient portal. Superbills will be visible when accessing the patient portal from a computer, but not from a phone.
The amount that your insurance company sends you, once you meet your out-of-network deductible and assuming you have obtained any necessary prior authorizations, is based on the percentage of out-of-network coverage your plan authorizes (typically 50-80%) of the allowable rate, which varies based on insurance plan. Please note that insurance plans typically do not cover Dr. Lerma’s time spent providing care in between sessions, so the cost of care outside of scheduled appointment times would be the primary responsibility of the patient, parent or guardian.
Do you accept Health Savings Account, Flexible Savings Account, or Health Reimbursement Account (HSA/FSA/HRA) debit cards?
Yes. If you have a pre-tax account set aside for healthcare expenses, you may use the debit card that is associated with that account. If you do not have one, ask your human resources department if you can set one up. Of note, some HSA accounts have limits regarding utilization, so it would be best to first review this with your provider.
How do I request a new patient evaluation for myself or my child?
You may request an intake appointment by calling Dr. Lerma at (925) 900-5959.
When and where are you available to meet?
Location: Dr. Lerma is offering a combination of telehealth and in-person appointments at this time. Telehealth appointments and intake appointments require Dr. Lerma’s approval prior to scheduling. Utilization of smart phones for telehealth appointments will require downloading the SimplePractice Telehealth app prior to our first appointment.
Work Days: Monday through Thursday
Hours: 9:15am to 12pm and 1pm to 5pm
What is your cancellation and no-show policy?
Once your appointment is scheduled, Dr. Lerma holds that time especially for you. As a courtesy to those who are on Dr. Lerma’s wait list, please call Dr. Lerma at least two business days prior to cancellation. For example, if your appointment is on Monday at 4pm, you would need to call Dr. Lerma no later than the previous Thursday at 4pm to cancel. If you do not provide two business days notice, you will be responsible for the full appointment fee. Unfortunately, insurance companies do not reimburse for missed appointments or late cancellations.
IF YOU, OR YOUR CHILD, ARE EXPERIENCING AN EMERGENCY, PLEASE CALL 911 OR GO TO YOUR NEAREST EMERGENCY DEPARTMENT.
ADDITIONAL RESOURCES:
NATIONAL SUICIDE HOTLINE: 988 or 1-800-273-8255
LGBTQ SUICIDE HOTLINE/THE TREVOR PROJECT: 1-866-488-7386, WWW.THETREVORPROJECT.ORG
SUBSTANCE USE HELPLINE (SAMHSA): 1-800-662-HELP (-4357), WWW.SAMHSA.GOV
MENTAL HEALTH SUPPORT ORGANIZATION: NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) EAST BAY, WWW.NAMI.ORG OR WWW.NAMIEASTBAY.ORG, 510-524-1250
LOCAL FAMILY GRIEF RESOURCE: HOSPICE OF THE EAST BAY (PLEASANT HILL), WWW.HOSPICEEASTBAY.ORG
AUTISM RESOURCE: REGIONAL CENTER OF THE EAST BAY, HTTPS://WWW.RCEB.ORG
ADHD RESOURCE: CHADD, HTTPS://CHADD.ORG
OCD RESOURCE: INTERNATIONAL OCD FOUNDATION, HTTPS://IOCDF.ORG
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Lastly, for informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here: https://openpaymentsdata.cms.gov. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.