Why don’t you participate with insurance?
It’s a valid question. Using insurance often reduces cost for you, both in- and out-of-network, and I know that’s an important factor when seeking an evaluation. I have several reasons, however, for not participating with insurance. First, selfishly, it takes a great deal of extra time and energy for me to submit and appeal claims – time not spent on your case. Insurance also takes a long time to process, so that if you have a deductible or coinsurance, you’re often paying me months after the service is completed. Also, insurance companies do not provide me a reimbursable rate that is nearly acceptable, given that it is such a technical and specialized service being provided.
To understand more about how insurance has been a challenge in mental health, you can read here an article posted by NPR.
However, while the financial outlay may be more inconvenient to you, there are some additional reasons that not using insurance may benefit you ~
Insurance will want to dictate what testing can be done and will not reimburse certain types of testing
Insurance will often not cover educational or learning disability testing. This may include cognitive (IQ) testing, academic or learning assessments, or personality/behavior assessments. Often they will not cover testing for ADHD. The rationale is that this testing should be done by schools – but families often need external evaluations to make sure their children are receiving appropriate learning supports at school. It’s chicken or the egg – insurance often won’t cover the testing needed to determine what the diagnosis might be.
Insurance companies also want evaluations to be “medically necessary” and require a diagnosis. You should know that if you or your child utilize insurance, any diagnosis I provide becomes a permanent part of your medical record. In some cases, this is good – because you get services associated with that diagnosis. But in other cases this can be a detriment – you may not want my findings to become a permanent part of your medical record – you have no control over he may sees your record, which can affect future insurance choices, school options, or future employment situations. With paying privately, you have much greater control over who knows about your diagnosis and when and how it is used. Even if you request a superbill (which I may be able to provide you, based on your insurance), you will find the work I complete may not entirely match the superbill because of the way insurance processes the scope of service (by hour, rather than by service).
Privacy and Choice
I’m also better able to protect your privacy. When you participate with insurance, psychologists try to minimize the amount of clinical information is released to insurance (just dates of service, codes, etc.), but psychologists can be audited at any time, meaning your (or your child’s) records must be made available to the insurance company and, quite possibly, various other “third party entities” (such as government agencies). With privately paying for your evaluation – with the exception of special cases (e.g., issuance of a court order, or in situations where someone’s life or safety is threatened) – I will never release your records without your written authorization.
Often insurance companies want me to submit a pre-authorization, which states which tests I would want to give and how much time I believe it will take. Insurance companies have the authority to not approve testing that I think is necessary, which means the evaluation may not be as thorough as both you and I want it to be. Paying privately means you get to consent to what tests are administered, who you choose to be assessed by, and what to do with the results when you receive them.
Predictability
When you utilize insurance benefits, sometimes you’ll have a copay, sometimes co-insurance, sometimes a deductible. While the psychologist has a standard hourly rate they may charge, the insurance will determine the allowable rate, and then will determine how much you will be responsible for. When all is said and done, you may be left with more questions than answers. Often we’re waiting on what the insurance company will say, and then it will drag out the payment process to long after the testing will be complete – an inconvenience for BOTH you and me.
There are no surprises, or possibilities of “extra” fees or “hidden” costs. Under the “No Surprises Act,” effective 1/1/2022, you will know what your fee is prior to the start of service, and that does not change without mutual understanding and a new agreement (find more information about No Surprises Act here: https://www.apaservices.org/practice/legal/managed/no-surprises-act).
