jehrenreich.com
Psychological Testing and Assessment
 

More details about insurance coverage for testing

1. If my insurance company does cover testing, do you accept what they pay as full payment?

It depends. 

Many insurance companies have a list of preferred providers or of providers who are on their "provider panel" or who are "in network providers." (I am currently on the lists of Blue Cross (Anthem), Oxford, Connecticare,  United Behavioral Health, and Husky). If I am on the panel of your insurance company, I will accept their payment schedule payment in full for those services they agree to cover, as long as precertification requirements have been met before the tests are actually administered. You remain responsible for paying any deductibles or co-insurance fees for the services that are reimbursed by your insurance company. 

Note that the insurance company may not agree to reimburse all of the services requested. For instance, they may cover personality testing but not psychoeducational testing, or they may cover only a fraction of the hours of testing requested. You remain responsible for paying for any portion of the services that is not covered. The fraction of the fee not actually covered will be billed at my full rate, even if I am on their panel of providers.

If I am not on the panel of your insurance company, or if you do not follow the procedure above and only seek reimbursement after the testing has been completed, or if precertification is required but has not been obtained prior to the testing, you must pay me directly and submit the bill to your insurance company to have them reimburse you. Under these circumstances, you will be responsible for the full cost of the services, regardless of insurance company fee schedules and regardless of what portion of the fee the insurance company reimburses.

2. What if the insurance company says it will pay but then denies payment?

Insurance companies often give incorrect information on the telephone. Even “pre-certification” is not a guarantee of payment. A final determination is made only when the claim is submitted. Regardless of any information you or I have been given, either over the phone or in writing, if the insurance company ultimately refuses to cover all or part of the services, you remain responsible for their full cost.

3. Does submitting my claim to my insurance company affect the confidentiality of the results?

Your contract with your health insurance company may require that I provide it with information relevant to the services that I provide to you. I am always required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information or copies of your entire Clinical Record. This information will become part of the insurance company files. Though the insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. If you request me to submit a claim to your insurance company, you are agreeing that I can provide requested information to your carrier.

4. Are there any other circumstances in which my records might not be confidential due to issues related to payment?

If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. Either procedure may require me to disclose otherwise confidential information, such as your or your child’s name, the nature of the services provided, and the amount due.  If such legal action is necessary, its costs will be included in the claim.

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