Insurance companies vary widely in their coverage for neuropsychological and psychological evaluations. I advise all of my clients to check extensively with their particular insurance company about benefits before the evaluation so you will not have any surprises.
With few exceptions, you will be personally billed for the charges for the evaluation. You will be provided with a “superbill” that has all the information your insurance company needs to process your claim, which you will need to submit to your insurance company. The office policy is for you to pay approximately 1/2 of the total bill at the third evaluation session and the remainder of the bill at the last follow-up session with parents.
I have elected to no longer be directly affiliated with insurance or managed-care companies, although many insurance companies will still cover these services for you. I have done this in order to maintain the highest quality and integrity of the services I provide to you and your children. Psychological and neuropsychological evaluations deal with complex issues that require a thorough study to answer the questions that have brought you to this office and to plan the strategies that need to be put into place to help your child. Your insurance company may or may not cover all of the essential components of a quality, comprehensive evaluation. However, as parents I know you will have a thorough understanding of your child and his or her needs following this evaluation. I will be happy to assist you with any insurance questions that may arise. Please don’t hesitate to ask.
Helpful Hints in Dealing with Your Insurance Company
It is always advisable and often required that you talk with your insurance company to let them know that you are seeking a psychological or neuropsychological evaluation before your first appointment. Be sure to do this so that a record is made of your call.
I will be an out-of-network provider with almost all insurance companies. I have elected to do this so I can provide the highest quality services to my patients. Most insurance carriers in Georgia are required to still pay for services they would pay for an in-network provider, however, they may reduce the percentage paid. Ask your insurance company what the specific benefits are for an out-of-network provider. If your primary care physician has referred you for an evaluation, he/she may be willing to write a letter detailing medical necessity to help in your negotiations with your insurance company. In cases where there is a history of head trauma, neurological complications or disease, epilepsy or seizure disorder, or other impacts to neurological functioning, you may be eligible to have your medical insurance cover a neuropsychological evaluation, rather than your behavioral / psychological insurance. Be sure to investigate this if this applies to you.
Insurance companies vary widely in what they will cover for psychological and neuropsychological evaluations.
For example, some companies provide coverage for possible attention deficit hyperactivity disorder, while others specifically exclude it. When a child is experiencing difficulty significant enough for you to seek an evaluation, it is important that all aspects of your child’s functioning be thoroughly assessed, so that you truly understand the needs of your child. However, many insurance companies will only reimburse for very minimal assessments, such as interviews with parents, rather than thorough evaluations.
The amount of paperwork, time spent on the telephone waiting to talk with someone about your particular case and then actually consulting with someone from the insurance company often becomes excessive for the psychologist.
To do this for the numerous patients/clients in my practice would not be possible. Therefore, parents/clients must take on this responsibility for their particular case.
As you explain what services you are seeking, some specific information may be helpful:
The initial diagnostic intake session for an evaluation or therapy is coded 90801/90791. Many insurance companies will fully cover this session. Some insurance companies will ask for a breakdown of the tests/procedures to be used in the evaluation after this initial session and the clinical rationale for the evaluation. I will be glad to provide you with a sheet detailing this information if you ask for it at the time of your initial session. You may then provide this to your insurance company so they can advise you directly of what they are willing to cover. Please note that you are still responsible for your total bill, regardless of what the insurance company elects to cover.
The CPT code for the hours of a psychological evaluation is 96101; the CPT code for a neuropsychological evaluation is 96118. You will be billed for the hours of time the psychologist directly devotes to your case. This includes direct test administration and assessment, scoring and interpretation, writing of a comprehensive report and the follow-up session when the results of the evaluation and recommendations are thoroughly discussed with parents. Excluding the intake session, these hours generally range from 10 – 14 depending on the complexity of the case. At the follow-up session (after the evaluation), you will be provided with a superbill which details all the information your insurance company needs to process your claim. You should submit this bill along with the company insurance form that provides your member identification information.
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