Using Insurance for a Neuropsychological Evaluation

safe

I am an in-network provider for the following

insurance plans:

Reading: How to get a neuropsych evaluation covered by insurance

  • first

  • kaiser permanent

  • aetna

  • regency*

  • blue cross/blue shield

    You should call your insurance provider and ask if the services you are seeking are a covered benefit under your plan. For example, you should call your insurance company and ask if your plan covers “neuropsychological evaluations” (cpt code 96118) or “psychological evaluations” (cpt code 96101). make sure you know what copays, coinsurance, or deductibles you might have.

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    If I accept your insurance plan, after completing your assessment, I will bill your insurance company directly. I do my best to let you know in advance if I anticipate there will be a problem with your insurance company to cover the cost of the evaluation. however, please note that benefits quoted over the phone by your insurance company, or by me saying I accept your insurance, are not a guarantee of coverage. you are responsible for the balance if your insurance denies payment. you are responsible for any remaining balance not paid by your insurance company.

    You’ll also want to note that some services that are a routine part of a neuropsychological evaluation of a school-age child (ages 7 and older) are not covered by any insurance plan. These educational services include:

    • a review of your child’s school records, such as report cards, ieps or 504 plans, or samples of your child’s work

    • get information about how your child is doing in school from you or your child’s teacher

    • direct tests of your child’s reading, math, or other academic skills

    • tests some processing skills such as phonological processing and

    • recommendations for the school environment

      This information is an essential component of your school-age child’s evaluation. That’s because your child spends a significant amount of time in school, so a comprehensive evaluation should consider what your child is like in an environment where he or she spends so much time. however, insurers consider educational services “not medically necessary.” Parents seeking a neuropsychological evaluation of a school-age child should be aware that they will be required to cover the cost of some educational services, and this cost will not be covered or reimbursed by any insurance plan. feel free to contact me for more information about this cost.

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      I am also available to attend iep meetings, program reviews, or consult with school staff, if requested and as my schedule allows. in fact, I love working with school teams and other professionals to help support your child. however, you should be aware that these services are not covered by insurance. ask me directly about my rates for these services.

      ***new as of January 1, 2017***

      Regence changed their networks effective January 1, 2017. These are the Regence plans I’m considered in-network with:

      • washington preferred, classic, innova, engagement, hsa (2.0, 3.0) – preferred network

      • washington activecare, platinum, gold, silver, bronze – network preferred; providence-swedish health network

      • uniform medical plan – network ump plus-pshvn; ump plus uw acne medication; uniform medical plan network

        I am not considered in-network at this time for the following regence washington activecare plans: evergreenhealth partners-virginia mason, multicare connected care, the everett clinic, or uw medicine networks.

        at this time, i am not in the cigna, first choice, united health care (coming soon!) or beacon health care network.

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