Important information about navigating insurance issues:
Dr. Hagerott is a participating provider for Smart Health. If this is the child’s primary insurance, we will collect the deductible/copay at the time of service and file insurance claims from our office. Important note: if the question is to evaluate for a learning disability; unrelated to a medical condition, this is generally not covered by any insurance carrier. Therefore; even if the neuropsychological provider is a participating provider with your insurance company, you should contact them to discuss your benefits and any disallowed diagnoses.
For other insurances, the full fee for service will be collected at the time of service and the parents or guardians of the child may self file for reimbursement from their insurance company. It is not possible to generate a testing plan prior to the initial consultation. After the initial appointment, the parent/guardian will be provided with information on the anticipated hours and fees associated for any recommended testing. You will be provided with a charge ticket with all information needed to file your claim to your insurance carrier.
If you are self filing your insurance, the following tips may help you navigate the process to request reimbursement for neuropsychological services:
- Call your insurance company (number on the back of the card) to determine if you have out of network benefits. If you do not have out of network benefits, ask if you can still file for out of network reimbursement. (Due to limited availability of pediatric neuropsychology services in this region of the country for young children, we have heard that some parents have been able to secure reimbursement, even if they have no out of network benefits.)
- Ask the insurance company representative to help you locate the claim form you need to send in (usually available on the insurance company website) and notify you of any exclusions for CPT (service) codes, disallowed diagnoses, and limitations on your policy. You will be sending in this claim form along with the charge ticket we provide at the time of service. Be sure to keep copies of all forms submitted.
- Be knowledgeable of any services requiring pre-authorization and what steps you need to take to secure pre-authorization. The most commonly used codes in this office are 90791, 90785, 90834, 90837, 96136, 96137, 96137, 96139, 96132, 96133. Any authorization forms the doctor needs to fill out to authorize testing should be brought to the first appointment. Any necessary paperwork or consultation necessary with the clinician should be completed within the clinical session. Additional paperwork will be billed to the patient at 15 minute increments of our usual hourly rate, if requested outside the appointment time, and may take up to 30 days to complete. Forms must be picked up at the office, so payment can be collected.
- Insurance companies may require that you demonstrate medical necessity in order to reimburse for services. Physician referral to request diagnosis and treatment of a condition may help your insurance company determine medical necessity. Therefore; when appropriate, you may want your child’s pediatrician/physician to refer your child and send appropriate medical records. When you send in claims, be sure to clearly indicate that you have already paid the fees for service and the check should be made out to you. Any checks received by our office may be sent back to the insurance company. This may delay your reimbursement.
Please note that our staff cannot research or advise you on any claims procedures for insurances for which we are not a participating provider. Therefore; if you have any questions, please call either your insurance company or your employer’s human resources office for assistance. Any request for records and clinical information made by a health insurance company to our office will not be processed, as we are not contracted with the company and do not have patient consent to release this confidential data.