Our office will send the requesting party an explanation of the services to be provided, an email with forms to be completed prior ot the initial appointment an payment instructions.
Patient's Responsibility seeking Insurance Reimbursement: Due to the variable nature of insurance reimbursement and authorization, patients are responsible for contacting their insurance carrier for coverage and payment. Our services are generally approved by insurance carriers for medical necessity. As a courtesy, our office will provide you with a superbill which you can send to your insurance company for reimbursement. If you have any questions regarding the necessary forms or payment policy, please feel free to contact our office at 949.478.4503 or email firstname.lastname@example.org
Insurance Carrier Disclaimer: “A coverage determination, prior authorization, or certification that is made prior to a service being performed is not a promise to pay for the service at any particular rate or amount. The patient’s summary plan description governs amount payable, as every claim submitted is subject to all plan provisions, including, but not limited to, eligibility requirements, exclusions, limitations, and applicable state mandates.”
We have found that the best way for a subscriber to receive the maximum reimbursement is for the subscriber to confirm their insurance coverage for medical care and their financial responsibilty for their particular plan. We encourage the patient/subscriber to call their insurer to confirm coverages and reinbursements (use the 800 number on the back of card) for Psychological and/or Neuropsychological Services, for the following CPT Codes: 90791 for Psychological Diagnostic Evaluation; 90834 for Psychotherapy; 96116 for Neurobehavioral status exam (medically-based); 96132, 96133, 96136, 96137, 96138, and 96139 for Neuropsychological Testing.
Due to the limited availability of service hours, we request a $300.00 deposit for the initial diagnostic appointment and consultation. 48 hour notice is required for appointment cancellations. Requests for Expedited or Time Definite (Deadline) Assessments will require a retainer at Forensic Rates.
Payments & Costs to the Patient. The costs of our service will depend on the type and complexity of service. Some of our services are not covered by some insurance carriers. The patient is reponsible for service charges not authorized or reimbursed by their insurance carrier.
Financial Policy. While the patient is responsible for all charges, insurance reimbursements reduce the patient's cost of the assessment. Many testing charges are reimbursed by insurance carriers. Written Reports for a 3rd party require an additional $500 deposit and charge and will be completed and delivered to the patient upon payment of all charges due. Upon completion and payment for services, any remaining deposit balance will be refunded promptly. As a patient convenience, we accept credit cards, personal checks and cash for deposits and services.
Testing Services with Written Report. Full payment for services, including report production, must be received before a comprehensive written report is provided.
Hearings or Testimony Participation. A full retainer must be received prior to the scheduling of any hearings or procedures requiring attendance and/or testimony, including preparation time and records review.
Deposits are due before the initial appointment and before the initiation of testing. Click On Image for Credit Card Slip