Below is a brief summary, followed by more detailed information.
- Although each situation is unique, neuropsychological evaluation is typically covered under health insurance benefits if there is a qualifying medical condition.
- Lakeshore Neuropsychology does not bill insurance but instead participates in private pay arrangements for some very important reasons (reviewed in "Why We are a Self-Pay Practice").
- We recognize that this may be quite challenging for most persons, so we have worked hard to develop payment options to make it more possible (detailed in "Ways to Help Pay for This").
- Among these options is that you can seek to be reimbursed from your health insurance, and for this, we have written a guide with detailed information for this purpose (covered in our "Step-by-Step Guide to Explore Health Insurance Reimbursement").
- Unfortunately, those who are Medicare-eligible are an exception to this process (please call our office for information regarding Medicare beneficiaries). For this reason, we have reserved a limited number of discounted services for those 65 and older, which may be an option (please call for details).
- For those who would like to review detailed information covered in the documents mentioned above, and also details about our flat rate evaluation fees and payment options (in our "Financial Policies and Fee Agreement") please call our offices (219-243-1912) and request our New Patient Packet.
Lakeshore Neuropsychology's Private Pay policy, and why we do not bill insurance:
Although each situation is unique, neuropsychological evaluation is typically covered under health insurance benefits if there is a qualifying medical condition
Unfortunately, with the rapidly changing healthcare landscape, policies can change unpredictably and without warning. Because of the investment of time required of a typical evaluation, it has become risky to depend on insurance coverage, especially because even pre-approval does not always ensure later payment for services. In any one case, providing documentation and writing appeals in the case of denial of payment can absorb hours of time better spent in clinical care. For this reason, Lakeshore Neuropsychology does not bill insurance directly and has established a simple financial policy of payment of services directly from the patient/family to the provider (Private Pay).
Private Pay is a growing trend in healthcare. The following are some of the many benefits:
- It provides transparency and efficiency (e.g. no hidden costs, no waiting for bills to process).
- Both the provider and the patient to retain more control of the process (e.g. insurance cannot dictate what is “covered” or stipulate how services are offered).
- It allows unparalleled privacy, because medical records pass only between the patient and provider, and are not subject to insurance review, or access by any other outside entities for billing, etc.
However, if you have health insurance and want to seek reimbursement for your evaluation, our office will be happy to provide detailed documentation of the typical information that insurance requires for this.
What to do so you have the best chances to receive reimbursement for neuropsychological evaluation from your insurance:
1. If you have not seen a physician for your concerns relating to brain functioning, it is a good place to start to schedule an appointment with a doctor. A trusted family doctor would work, or you may even seek a specialist (e.g. neurologist or other specialist who understands brain-related disorders). It will be important to share your concerns and questions, so that they may evaluate any contributing conditions (e.g. underlying thyroid disorder, medication side-effects, etc.). It will also help for the physician to identify possible medical diagnoses. This helps with the need to establish medical necessity for possible insurance coverage. It is important to request a copy of the progress notes for this physician visit, both for possible insurance reimbursement, and for the neuropsychologist to review for the evaluation.
2. After the medical evaluation, referral may be made for neuropsychological evaluation. If your doctor is unfamiliar with this type of evaluation, we have a special referral form that you can take to your doctor, which may help clarify the medical reason for the evaluation (see our "Physician's Referral for Neuropsychological Evaluation". A physician's referral is often required by insurance companies to be eligible for reimbursement. It is important to note that a doctor's order is not required for a neuropsychological evaluation (e.g. you may self-refer), but not having one may make insurance reimbursement more difficult.
3. If you decide at this point to pursue neuropsychological evaluation, you can contact your insurance and research possible reimbursement (see our "Step-by-Step Guide To Explore Health Insurance Reimbursement"). You should provide them with your physician's diagnoses (on the referral form), and with the standard billing information from our offices (in the "Step-by-Step Guide . ."). At this point, they can advise you about the likelihood of reimbursement, and it is best to keep careful records of this information. They may ask you to complete paperwork so that the neuropsychological evaluation can be pre-authorized, or pre-approved, or they may ask for your physician to complete these forms. It is important to note that Lakeshore Neuropsychology cannot work directly with your insurance in this process, although we will do our best to support you with all relevant and reasonable information.
4 After you have explored insurance reimbursement, you can decide at that point if you would like to pursue neuropsychological evaluation. If so, you may contact our offices, and we will review your information and offer scheduling as appropriate.
5. Prior to your appointment, you will be provided a copy of our financial policies form ("Financial Policies and Fee Agreement"), which includes our fee schedule and payment policies.
6. Following the completion of your neuropsychological evaluation, you may follow up with your insurance for reimbursement. It is notable that they may require that you submit records at this point (e.g. billing information, the final neuropsychological evaluation report). These records will be provided to you as part of our standard process at the final appointment in our offices.
7. It is important to note that no guarantees can be made with regard to insurance reimbursement, and that even pre-approval is not necessarily a guarantee of later reimbursement. In essence, your insurance will make the final determination. Again, Lakeshore Neuropsychology cannot directly participate in appeals or other negotiations with insurances regarding payment for services, although we will be available to assist patients and families with questions and support.
So, what will this cost?
Neuropsychological evaluations provide a detailed understanding of a person’s abilities and behaviors, which is important for accurate diagnosis, and targeted recommendations. For this reason, evaluations are time intensive.
Although the testing materials themselves are part of the cost, the bulk of the cost relates to the time to complete the interview and testing (from 4 to 7 hours, depending on the complexity), and the careful review and documentation of the findings (e.g. 3-5 hours), and also the time to review findings with the person and his/her family, and provide ongoing consultation as needed (e.g. 2-3 hours). Taken together, the time to complete all of the activities of a neuropsychological evaluation are typically between 12 to 15 hours.
This process, although time-intensive, can provide highly effective information to help direct care and help the patient and family live life to the fullest, even in the case of significant brain-related illness.
Compared to other typical needs we face, the cost is roughly similar to a complex car repair, having some dental work done, or calling in an electrician or plumber for a home repair issue.
For a detailed summary of our flat-rate neuropsychological evaluation fees, and various payment options, please call our offices and request a New Patient Packet, which will include our "Financial Policies and Fee Agreement."
For some practical steps anyone can take to support brain functioning, (see “What you can do today to support brain functioning”). We can mail this out, or we can email it to you (you may request this through our contact form on this website).