Will my insurance pay for this?
Although each situation is unique, neuropsychological evaluation is typically covered under health insurance benefits if there is a qualifying medical condition.
Dickinson Psychological Services does not bill insurance, but instead participates in private pay arrangements. However, if you have health insurance and want to seek reimbursement for your evaluation, our office will be happy to provide detailed documentation of the typical information that insurance requires for this.
Unfortunately, those who are Medicare-eligible are an exception to this process (please contact our office for more information regarding Medicare beneficiaries). For this reason, Dr. Dickinson provides a range of cost-effective options for those 65 and older.
What to do so you have the best chances to receive reimbursement for neuropsychological evaluation from your insurance:
1. If you have not seen a physician for your concerns relating to brain functioning, it is a good place to start to schedule an appointment with your doctor. A primary care provider or specialist (e.g. neurologist or other specialist who understands brain-related disorders) is recommended. It will be important to share your concerns and questions with your provider so that they may evaluate any contributing conditions (e.g. underlying medical conditions, medication side-effects, etc.). It will also help for the physician to identify possible medical diagnoses. This helps with the need to establish medical necessity for possible insurance coverage. It is important to request a copy of the progress notes for this physician visit, both for possible insurance reimbursement, and to send to Dr. Dickinson to review for the evaluation.
2. After the medical appointment, a referral may be made for neuropsychological evaluation. Your doctor may complete a special referral form (see the Contact Us tab) or fax the referral to 855-719-2484. A physician's referral is often required by insurance companies to be eligible for reimbursement. It is important to note that a doctor's order is not required for a neuropsychological evaluation (e.g. you may self-refer), but not having one may make insurance reimbursement more difficult.
3. If you decide at this point to pursue neuropsychological evaluation, you can contact your insurance and research possible reimbursement . You should provide them with your physician's diagnoses on the referral form. Your insurance provider may require procedure codes. If that is the case, please contact Dr. Dickinson’s office for a list of codes associated with neuropsychological testing at the time of scheduling.
Your insurance provider can advise you about the likelihood of reimbursement, and it is best to keep careful records of this information. They may ask you to complete paperwork so that the neuropsychological evaluation can be pre-authorized, or pre-approved, or they may ask for your physician to complete these forms. It is important to note that Dickinson Psychological Services cannot work directly with your insurance in this process, although we will do our best to support you with all relevant and reasonable information.
4. After you have explored insurance reimbursement, you can decide at that point if you would like to pursue neuropsychological evaluation. If so, you may contact our offices via email or this website (see the Contact Us tab), and Dr. Dickinson will review your information and offer scheduling as appropriate.
5. Prior to your appointment, you will be provided a copy of our financial policies form, which includes our fee schedule and payment policies.
6. Following the completion of your neuropsychological evaluation, you may follow up with your insurance for reimbursement. They may require that you submit records at this point (e.g. billing information, the final neuropsychological evaluation report). These records will be provided to you as part of our standard process at the final appointment in our offices.
7. It is important to note that no guarantees can be made with regard to insurance reimbursement, and that even pre-approval is not necessarily a guarantee of later reimbursement. In essence, your insurance will make the final determination. Again, Dickinson Psychological Services cannot directly participate in appeals or other negotiations with insurances regarding payment for services, although we will be available to assist patients and families with questions and support.
So, what will this cost?
Neuropsychological evaluations provide a detailed understanding of a person’s abilities and behaviors, which is important for accurate diagnosis, and targeted recommendations. For this reason, evaluations are time intensive.
The cost relates to the time to complete the interview and testing (from 4 to 7 hours, depending on the complexity), and the careful review and documentation of the findings (e.g. 3-5 hours), and also the time to review findings with the person and his/her family, and provide ongoing consultation as needed (e.g. 2-3 hours). Taken together, the time to complete all of the activities of a neuropsychological evaluation are typically between 12 to 15 hours.
Dr. Dickinson provides more streamlined neuropsychological evaluations to those 65 and over, consisting of approximately 2 hours of interview and testing, and approximately 1 hour to review test results.
Please see the New Patient Information tab to learn more about the types of evaluations performed.
This process, although time-intensive, can provide highly effective information to help direct care and help the patient and family live life to the fullest, even in the case of significant brain-related illness.
Compared to other typical needs we face, the cost is roughly similar to a complex car repair, having dental work done, or calling in an electrician or plumber for a home repair issue.
For a detailed summary of our flat-rate neuropsychological evaluation fees, and various payment options, please contact our office and request a Financial Policies and Fee Agreement.