Insurance and Fee Policy

                                   Important Insurance Information to Know   

     With Neuropsychological Evaluations and Insurance, there are some particularly important things to keep in mind regarding dealing with insurance companies when trying to get them to pay for the  professional healthcare services by neuropsychologists. One important term used by insurance companies, regarding reimbursement,  is “Medical Necessity.”  This means that the service is necessary according to medical judgment.  For example, a learning disability evaluation may be viewed by the insurance company as not medically necessary, because they will consider this as an “educational issue.”  Many insurance policies explicitly exclude learning disability evaluations because they are viewed as something that should be handled by the school systems.  

     Our view at NEAT Center of Austin is that any unique and diverse cognitive processing, and/or cognitive problem(s), is a medical necessity and deserves to be evaluated.  If an individual is having trouble related to cognition/neuropsychology in school, work, and/or in their personal life, or there is a problem in learning, reading, memory and/or reasoning, it is important to get a valid, reliable, thorough assessment for diagnosis, treatment planning and prescription recommendation(s).  

     Moreover, some insurance companies want to get a prescription from a medical doctor (MD) which says that the doctor wants a “Neuropsychological Evaluation, CPT code 96118.”  The CPT code is a procedure code which tells what the service is. The medical doctor can write this on his prescription pad, and a copy of this can be sent to us and to our billing service.  Sometimes the insurance company will not tell the professional how many hours are granted and at what rate; of course, it is unreasonable to expect someone to agree to do something before knowing the terms, but this is common with insurance companies.  This is important to keep in mind because a neuropsychological evaluation usually consists of about 8 hours of testing and 7-14 hours to score the tests and write the report, or approximately 22 hours of professional time. 

                     MEDICAL HEALTH BENEFIT versus MENTAL HEALTH BENEFIT 

     Because you are in need of, and requesting, a neuropsychological evaluation, there is a medically presumed neurological disorder.  This means that a neuropsychological evaluation is considered necessary under Medical Benefit and NOT Mental Health Benefit.  For fees covered under the Mental Health benefit, the insurance company usually pays 50 percent; for Medical benefits however, as in the case of a neuropsychological evaluation, the insurance company will often pay 80 percent (or sometimes higher).

     There is another thing to keep in mind when dealing with insurance companies, when asking about reimbursement or coverage for a neuropsychological evaluation, one should never use the terms learning disability, dyslexia or attention deficit/hyperactivity disorder when talking with insurance representatives about this.  These diagnoses are either considered to be “educational,” (as noted above), or deemed not in need of testing, which is sometimes stated for ADHD.  We believe that these are unethical excuses for not paying for medically necessary testing.  The important thing to keep in mind is that you are asking for an evaluation to have a specialized professional precisely figure out what is going on, not to document what you already know.  Otherwise, there would be no need for testing.

    It is HIGHLY unlikely that insurance companies will have any neuropsychologists on their panels.  Even if they do, it is likely that the evaluation will not be a very thorough one

(likely 1 to 2 hours of testing versus 8-10 hours and a 3-5 page report versus 50-100 pages from the NEAT Center Austin).  Yes, you can always ask for a neuropsychologist on the insurance company panel, but remember it is to the insurance company’s advantage that impairments are not found, just as it is to a school system’s advantage to not find impairments in the children they test; if problems are found, they are then obliged to support treatment.

     What this comes down to is that you will probably have to fight for your rights.  But if you do fight properly, you will likely get paid for the evaluation and we will help you in every step of the way.  However, you also need to understand that the professional wants to be assured of getting paid.  For these reasons, it is understandable why almost no neuropsychologists will take assignment for their evaluations. As the professional, we have no legal rights in the contract you have with the insurance company, so they can deny payment, and we have no recourse.

                                  NEAT Center of Austin Insurance Policy

     For the past 12 years Dr. Reynolds, and the Neuropsychological Evaluation and Therapeutic Center of Austin,  has not taken insurance assignment because of problems with getting paid/reimbursed as well as insurance trying to dictate the amount of time, and quality of assessments, administered.  This is true for most neuropsychologists (especially with more than 10 years of experience -- and you want someone with this level of experience).  That being said, we have been trying to find a way through lobbying, and other courses of action,  to get insurance companies to pay for these evaluations, since we think they have an obligation to support these services (considered here as medical necessity neuropsychological evaluations).  

     In conclusion, like most private psychological practitioners, especially specialized neuropsychologist practitioners, the doctors at NEAT Center of Austin are out-of-network providers and we do not accept insurance directly. However, we will work hard to make the reimbursement process as smooth as possible for you by providing all the necessary paperwork, including receipts and diagnosis codes, in a timely fashion.