FEES AND INSURANCE

Fees and Insurance – Common Questions and Answers

Clinicians affiliated with NWPR/CFMAL are independent and set their own fees. These fees are set in accordance with guidelines suggested by the Health Care Financing Administration (HCFA), reimbursement schedules of insurance companies, and with those charged by other local mental health practitioners.

Your clinician’s contract with individual insurance companies may require him/her to work within this company’s fee structure. Portions of fees may be written off to account for these differences. It is often not until the insurance company has processed the claim that we really know who owes what.

Please refer to your clinician’s biography page on this website for specific information regarding their fees.

Will My Insurance Help with Costs?

Most health insurances cover counseling, psychological, and neuropsychological services.

However, almost every policy is different in this regard. Some require percentage co-pay, while others a flat per-visit co-pay.

We suggest you contact a customer service representative with your insurance company to see what benefits you can expect. When calling, we suggest you ask the following questions:

1. What does my policy cover for outpatient mental health services?

2. What remains on my deductible, if I have one?

3. Do I need a special referral to see a psychologist? If so, by whom?

4. Is there any special paperwork or authorizations my doctor will need to fill out?

5. What is my coverage for psychological or neuropsychological testing?

Do You Accept Medicare?

Yes.

Services to mature adults and disabled individuals are a common part of

neuropsychological practice.

Psychologists and Clinical Social Workers are qualified to provide Medicare services. Medicare coverage does not typically cover the entire fee. After certain write offs the clinician must make, you may still be subject to co-payments and deductibles.

Do You Accept Medicaid?

Unfortunately, no. Persons with Medicaid are required to seek services through agencies contracted to receive State funding in this manner.

Our office staff can provide you a list of these agencies, upon request. Practitioners such as those at NWPR and CFMAL are not allowed to provide services to Medicaid recipients, nor will Medicaid pay if they are a secondary insurance.

There are a few exceptions with respect to State-subsidized insurance programs:

1. Persons with Molina or Amerigroup can be seen by clinicians who have contracted with them to accept these services. Keep in mind not all clinicians contract with these insurances, and some must limit the number of patients they can take at any one time.

Nonetheless, some of us maintain these contracts out of desire to serve a broad range of clients and as a professional courtesy to referring physicians, especially when the expert diagnostic services we provide are not otherwise available in the community.

2. Persons referred by State agencies (i.e., Labor and Industries, Child Protective Services, Social Security, Department of Social and Health Services) are usually covered by the referring agency.

For example, CPS may send a child or adult for examination and will pay for these services.

Can I use Insurance for Services Relating to Guardianships, Lawsuits, Competency, Fitness for Duty, and Public Safety Screening?

Probably not.

These services fall under a category of forensic services.

This means that the services are provided to serve a legal or employment purpose at the request of the third party.

The third party in such cases may include a lawyer, insurance company, judge, case worker, guardian ad litem, school district, government agency, or current or prospective employer. These may be important assessments but are not considered medically necessary by your insurance company.

As described by the National Academy of Neuropsychology, the responsibilities of the neuropsychologist in the context of performing an independent forensic examination differ from those of the clinical examination.

Many people are confused about the difference between clinical and forensic services.

Although they both share many methods in common, these types of services fall under two different “umbrellas.”