Out-of-Network Provider Reimbursement

We understand that insurance can be a major consideration for many of our clients. That’s why we strive to make the reimbursement process as straightforward as possible.

As of Jan 1, 2023, our practice no longer bills insurance for testing services. The decision to become a self-pay practice was based on the increasing limitations that insurance companies were placing on us including denying coverage of ADHD and learning disorder assessments.

• What does this mean?

  It means we will not send a bill to your insurance company directly for any of our services. Instead, you will be responsible for the payment upfront. You will then submit your paid invoice to the insurance company and they will provide you with any reimbursement your policy provides. We will help you through this process.

• How much will I get reimbursed?

  Most plans pay 50-80% of the service fee back to the patient once their deductible is met. For example, if your evaluation fee is $800 and your policy covers 50%, you will pay $800 to our practice and your insurance company will send you a check for $400. You can get an idea of what your policy covers by using the calculator tool below or calling the number on the back of your card. The tool below only allows you to look up therapy coverage only, but know that the same reimbursement (per hour) is used for evaluations. The amount reimbursed for therapy (usually $50-$120 per hour) will be multiplied by the number of hours in the evaluation (typically 8-12 hours). We will help you verify your coverage ahead of making any appointments to ensure you understand your insurance benefits.

• What does insurance cover or not cover?

  Insurance companies will only cover assessments that are considered “medically necessary”. During your intake appointment, we will discuss the need and purpose for the evaluation. Most of our clients are in need of testing (or you wouldn’t be reaching out). An example of a non-medically necessary assessment would be cognitive testing for the purpose of gifted eligibility in school. In addition, insurance does not cover anything educational as they are not considered medically necessary. Several insurance companies will not cover ADHD assessments. Please reach out so we can help you understand your coverage limits.

• Will you submit the out-of-network claims for me?

  We partner with several claims-processing companies who will submit your claim to insurance on your behalf, if interested.