Dealing With Insurance

This post explains how to put yourself in the best position to achieve a successful pre-authorization for psychological testing services.  

While some clients forego insurance and pay out of pocket to keep their personal health information private, insurance plans often cover these evaluations, although you should always check your specific plan.

 Many times, insurance might state they require a “pre-authorization” for testing services.

The following suggestions put yourself in the best position to receive an insurance authorization:

1.     Contact your insurance company by dialing the number on the back of your insurance card.

2.     Know going into a discussion that neuropsychological testing is often covered, whereas educational (academic achievement) testing is rarely covered. Psychological testing depends on plan-specific provisions.

3.     Neuropsychological testing often focuses on specific medical questions related to a loss of functioning, intellectual disability, or potential ADHD.

4.     Having a medical or therapy provider complete a referral for assessment often provides additional evidence for insurance companies that testing services are necessary.

5.     Personality testing, while fascinating and very important for people experiencing consistent difficulties at work, home, and with others, is not covered by insurance and always a private pay evaluation.

6.     Adult autism evaluations may require an out-of-pocket charge. Usually, adults will be asked to provide a contact of someone who knew them during their childhood for additional information on the day of the evaluation.

7.     Some insurance policies do not allow for a re-test within a 12-month period.

8.     You will want to ask your insurance provider if they cover the following CPT codes, which are used to document testing services performed in the office: 90791, 96136, 96137, 96132, 96133, 90887.

9.     Finally, if testing is covered, ask if you need a “pre-authorization” to answer your specific referral question. When talking to any psychologist, you may consider asking if they are an “in network” or “out of network” provider. This will help you know if the professional accepts your insurance. Dr. Burgoyne is in-network with United Health Care, Aetna, Medicare, and Medicaid.

I hope this clarifies some steps you can take when considering a psychological evaluation. Until next time. -Brian Burgoyne, PsyD