Insurance

Insurance Verification

All Insurance will be verified by our office about a week prior to the initial appointment. Our office will contact the patient to go over the plan benefits at that time. This is due to the volume of referrals our office receives and the limited staff to schedule appointments and verify benefits. During scheduling we usually tell patients when it comes to benefits “no news, is good news”. This means if the patient does not receive a call from our office to go over the benefits. That means the patient is either covered at 100% or only has a co-pay. If a patient has a deductible that has to be met first or if there is another issue with the plan. We will contact the patient to go over that information. Please do not assume that the patients mental health benefits are always the same as their medical benefits. A patient may have a co-pay when they go see their PCP or another physician but have a deductible that applies to our office, or a deductible and a co-pay, just a co-pay, they may be covered at 100%, or there may not be any mental health coverage at all. We also experience situations where patients were informed by their providers office or the member services department that our office is in-network with their plan only to find out after we verify the benefits with the provider services department that our office is out-of-network. This is typically determined by a providers zip code, however this is not the only factor that can determine whether a providers office is in or out of network for a patients plan. Providers offices may not be made aware of the other factors and are simply informed that they are out-of-network. We encounter these scenarios all the time so please do not give our staff a difficult time about this.

Pre-Authorization

Some insurance providers require pre-authorization requests to be submitted for approval for Neuropsychological testing.  This process can take some time depending on how long it takes the pre-authorization department to process each request.  Each insurance provider has a different process for how pre-authorization requests can be submitted, and the specific documentation required.  Some conditions being tested for may even require an additional step in the form of a preliminary assessment that has to be completed by the patient and submitted by our office as part of the pre-authorization request. Some pre-authorizations may be approved, and some may be denied.  In the event of a denial our office may have to submit additional paperwork at the request of the insurance provider that the patient may have to obtain from their referring doctor.  Our office will work expeditiously to submit all the necessary paperwork in a timely manner, as it becomes available to us, so that we may obtain a pre-authorization approval on your behalf. If our office is unable to obtain an approval after all necessary documentation has been submitted then it means the pre-authorization department has determined that the evaluation is not medically necessary.

Here's what to know:

• Different insurers have different processes and requirements for pre-authorization

• Sometimes, an additional assessment might be needed before approval

• Decisions can be approved or denied

• If denied, we may need extra paperwork from your doctor to get approval

• We'll handle all the paperwork quickly to get your approval as soon as possible

Note: Pre-authorization approval does NOT mean the cost of the evaluation is paid for by the insurance. The pre-authorization approval only means that the insurance company has deemed it medically necessary and has greenlit the patient to have the evaluation done. The cost for the evaluation still applies to the patient whether that be in/out of network benefits.