Do you accept my insurance?
My practice is not in-network with any insurance providers. This is because insurance companies impose requirements that can negatively impact the quality of care. Examples include limiting the length and frequency of appointments and restricting the services that can be provided. They can also require that psychiatrists perform time-consuming administrative tasks that shift the focus away from providing great mental healthcare. I have chosen to instead use that time to care for my patients, read scientific papers and attend conferences to help me provide the best care possible, educate and engage with the community, and advocate for mental health equity. I am regretful that my practice is not a fit for some patients because we are out-of-network. Please see the next FAQ item for tips on how you can still use your insurance benefits to receive care in my practice.
Is there a way to use my insurance benefits to see Dr. Lester?
Yes, you can request out-of-network reimbursement from your insurance company after paying for your appointment. If approved, they will reimburse you for a percentage of their maximum allowable amount for that service. It's important to note that you may have a deductible - an annual amount that you must spend out-of-pocket on healthcare - that must be met prior to insurance providing any reimbursement. For example, your insurance company might reimburse you for 80% of the cost of appointments with me, but only after you have spent $2,000 on healthcare that year. If you plan to use out-of-network benefits, I recommend discussing the details of your policy with your insurance company before committing to appointments with me.
Additionally, you can request a "network gap exception" from your insurance company, which means they will pay for a higher amount of your appointment fees as if you were staying in-network. Network gap exceptions are commonly granted if your insurance company cannot provide you with a certain type of care within a reasonable time frame. As it's highly unlikely that your insurance company will be able to provide an in-network child & adolescent psychiatrist in a timely manner, you'll likely be successful in negotiating a network gap exception.
Why do you use a therapy dog?
There is scientific evidence that the presence of a therapy dog during mental healthcare provides benefits such as helping patients to feel safe and comfortable. My therapy dog, Elmo, has been seeing patients with me since January 2022. Patients have said that they love having him in their appointments and look forward to seeing him.
What if I or my child are allergic to dogs?
If you have an allergic reaction triggered by contact with dogs then I do not recommend having in person appointments with me. One option would be to see each other using telehealth, which is just as effective as in person appointments in most cases.
What if I or my child are afraid of dogs?
Spending time around a calm, gentle, well-trained dog can be a great way to work toward conquering a fear of dogs. If this is not currently your goal then one option is to see each other via telehealth.
Do you offer video appointments/telehealth?
Yes, I offer telehealth appointments using Zoom Healthcare, a secure, encrypted platform that is widely regarded as the top telehealth conferencing app. A patient must be physically located in California during the telehealth appointment. Telehealth can be a great, convenient option for busy professionals, students, those located in remote or rural areas, and anyone who prefers to have a psychiatry appointment from the comfort of their home. In most cases telehealth is just as effective as in-person appointments. One exception is an evaluation for suspected autism, which I believe is more effective in person. We can decide whether your first appointment will be via telehealth or in person during your free phone consultation.
Is telehealth secure? Can a hacker listen in?
In my practice we use Zoom Healthcare for video conferencing, which is secure and encrypted such that no uninvited parties can intercept your private information. New links are generated for each appointment so that only the patient and I have access to that specific link. I also utilize a virtual waiting room so that even if a stranger gained access to your appointment link they would not be able to enter the meeting. No technology is perfect, but telehealth is very safe and secure when using appropriate technology. I recommend planning in advance so that you will be in a private place where no one can overhear you during the appointment. All of this being said, it is your choice whether to schedule a telehealth appointment, and you are free to schedule your appointments at one of my office locations instead.
What happens in an initial evaluation?
An initial evaluation is one or more appointments that occur after we have had a brief phone conversation to determine whether our practice might be a good fit for you. The specific details depend on the type of patient.
Child & Adolescent Evaluations:
The first appointment typically lasts 90 minutes, during which I directly interview the young person and collect additional information from the parents or caregivers. For younger children I spend more time with the parents, and for teens I spend more time with the teen themself. For children 11 or younger it is possible to split this into one 60-minute, parent-only appointment, and one 30-minute appointment with the child present. This allows the child to miss less school and avoid sitting in the waiting room during the parent interview. After the session, Dr. Lester will collect more information, which may include reviewing medical records, sending questionnaires, and speaking with therapists and teachers. The second session typically lasts 60 minutes, during which Dr. Lester shares diagnostic information and makes recommendations.
The first appointment can last 60 or 90 minutes depending on what type of evaluation is needed and whether you need help with complex problems. In some cases, diagnostic information and treatment recommendations may be shared at the end of this session. Depending on your specific mental health needs, more information may be necessary, such as reviewing medical records, interviewing loved ones, or sending questionnaires.
After the initial evaluation is complete, you and Dr. Lester will discuss whether ongoing care in our clinic is a good fit. If you both feel it is a good fit, you will collaboratively decide on a treatment plan, which will include the type and frequency of sessions. Once a treatment agreement has been reached, a physician-patient relationship will be established.
Please note that medication prescriptions are not promised or guaranteed when an initial evaluation is scheduled.
Do you handle disability paperwork or offer other legal services?
My practice focuses exclusively on caring for patients, and therefore does not offer legal services. This includes disability evaluations or paperwork, workman's comp evaluations, child custody evaluations, fitness for duty evaluations, writing letters for court, FMLA paperwork, and other formal documentation for legal purposes. Patients and families who require these services are best served by obtaining them from a neutral party who is not involved in their healthcare. Please note that I consider letters recommending a 504 plan or individualized educational plan (IEP) a necessary part of patient care for patients who need those interventions, and therefore I do not consider these to be legal services. I handle emotional support animal (ESA) letter requests on a case-by-case basis, and I only consider writing them for well-established patients who have been part of my practice for a minimum of a few months prior to making the request. For any other type of documentation requests, please make sure you mention the request when you complete the new patient appointment request form.
Will you prescribe medication after the first visit?
I do not guarantee that medication prescriptions or refills will be provided. If I deem a medication medically appropriate and we mutually agree on a treatment plan, a prescription may be provided. This usually does not occur until the initial evaluation is complete, which requires 2-3 appointments. Sometimes after meeting a new patient I feel that medications that they have been taking under the care of another provider are harmful to the patient. In such cases I do not prescribe the medications in question. If you are about to run out of medication, I recommend contacting the last provider who prescribed the medication or your primary care provider.
Do you accept money or gifts from drug companies?
I do not accept payment, gifts, meals, or anything else with monetary value from pharmaceutical or medical device companies. There is scientific evidence that such exchanges can influence physician decision-making. I strongly believe that it is necessary to abstain from this type of exchange to maintain objectivity and provide excellent patient care. You are invited to verify this by clicking the button below to visit the Centers for Medicare and Medicaid Services (CMS) Open Payments database webpage.
Open Payments Database
Do you share information about adolescent patients with their parents?
I believe that involving caregivers in the care of young people is important. However, I feel it is equally important to provide them with a safe and trusted space where they can share their thoughts freely. Therefore, I hold the information shared by them in confidence. I do share diagnoses and treatment recommendations with caregivers so that they can understand how to support their young person. I may also share information that would place someone in imminent danger if it were withheld. For example, I would not tell a parent if a teen patient confided in me that they used recreational drugs, as long as the drug use did not place them in immediate danger. However, I would tell their parents if the young person told me they were planning to end their life. I am also legally obligated to notify the authorities if I hear about a person under 18 or a person over 65 that are being abused.
How do you handle patient data and privacy?
I take the privacy and confidentiality of my patients seriously. In general, I do not share adult patients' private information without their explicit consent. There are some exceptions such as sharing with the company that runs my electronic health record system, since your information is entered into the health record stored on their servers. Some information may be shared in an emergency to prevent something bad from happening. You may download my Notice of Privacy Practices document below. For adolescent patient confidentiality concerns please see the separate FAQ item.
Dr. Casey Lester specializes in the mental well-being of adolescents and young adults.
At Casey Lester, MD, we provide the highest quality eye care to all our patients. Schedule your appointment today.
One fine body…