Can health insurance be used to cover the cost of services?
Neuropsychological Evaluation services will generally be covered under your Medical rather than your Mental Health/Behavioral Health coverage. Because a Neuropsychological Evaluation is typically covered under your Medical coverage, it usually requires a referral from a Physician (your Primary Care Physician, Physiatrist, Neurologist, Neurosurgeon, or other physician) with a written statement that the service is considered medically necessary, which establishes that the referral is needed in order to provide the most appropriate care (i.e. for differential diagnosis, baseline testing prior to intervention, or to help guide the treatment plan).
Evaluations for attention deficit disorder or learning disability are generally not covered by most insurance companies since this service is viewed as the responsibility of the public-school system under IDEA regulations.
Psychotherapy services and/or cognitive rehabilitation may be covered under either Medical or Mental Health/Behavioral Health coverage, depending on the reason for services. Caregiver services and support may be covered under insurance or may be an elective service not covered under medical insurance plans. Should you wish to utilize health insurance benefits for services, our office can assist you in determining if services are covered by your plan.
The Center for Rehabilitation Psychology and Neuropsychology, PC, accepts most insurance coverage including Aetna, Blue Shield of California, Blue Cross of California, Anthem Blue Cross, Cigna, United Health Care, and Delta Health Systems, however, we are not contracted providers for these networks. To utilize your out-of-network benefits through your insurance for our services, you must have a PPO plan. With a PPO plan, your insurance company may pay for part of the cost of the evaluation, cognitive rehabilitation, or other intervention services. Out-of-network coverage most often ranges between 50 to 75% of the total balance, depending on your policy. You would be responsible for the balance of the costs of the services. We encourage you to familiarize yourself with the specifics of your insurance plan for more information.
If you anticipate having difficulties paying for your portion of the cost, arrangements for a payment plan can be put in place. Before you decide to proceed with any of the services we provide, with your permission, our personnel will contact your insurance company and take the steps necessary to obtain authorization and information regarding the estimated amount that you may be held responsible for. As a consumer you should be aware that different costs are associated with different levels of assessment and treatments.
What are the rates for services?
Evaluation Services:
For neuropsychological evaluations, appointments typically require 3 to 6 hours, depending on the referral question, with fees usually ranging from $900 to $2,500.
For psychological evaluations, appointments typically require 2-4 hours, depending on the referral questions, with fees usually ranging from $600-$1500.
For all evaluation services, fees include charges for face-to-face services, as well as for scoring and preparation of the evaluation report. Depending upon the circumstances and specific nature of the case, the number of hours and fees may be greater or less than the stated range.
Intervention Services: (Psychotherapy, Cognitive Rehabilitation, Behavioral Management, and Caregiver Support services)
The hourly rate for intervention services is $175 for individual therapy sessions and family therapy sessions, and $75 for group therapy sessions.
What are the potential benefits of not using my health insurance for services?
There are several reasons that people may not want to use insurance coverage for therapy services. Most insurance companies require personal information about you and your treatment, including a diagnosis and information about your treatment and progress in therapy, in order to approve services. This information then becomes part of your medical record and may be accessible by other agencies in the future, such as health or life insurance agencies, and potentially even employers and lending agencies. It could also impact your ability to serve in the military. Insurance companies have the right to approve or deny services based on your diagnosis and the type of treatment you are receiving. They can limit the number of sessions you are allowed and the type of treatment you can receive.
What is your cancellation policy?
If you are unable to come to your session or evaluation and need to cancel, please let us know more than 48-hours in advance. If you do not attend the appointment without giving adequate notice, you will be charged $250 for a missed evaluation appointment, and $75 dollars for missed intervention appointment.
How can I schedule an appointment?
There are several ways that you can schedule services at our offices. You may call our main office number at 925-322-3100, you may have your physician fax a referral to 925-322-2817, or you may click on the link below to link to our clinic scheduling.
Dr. Struchen is available for free consultation over the phone to determine if our Center is the appropriate place for your service needs and to answer any questions you may have about our services.