I hope you can find here the basic information you need about cost, payment, schedulling and use of insurance for Assessment/Testing and Psychotherapy. If you still have questions after reading the sections that apply to you, please feel free to give me a call so we can discuss your case in more detail.
I am an in network provider for the following plans:
I am also a PPO provider for Blue Shield.
What is the fee for testing?
Fees vary, depending on the extent of the testing requested and are based on the unique needs of each person. Please contact me for more information.
What does the fee cover?
The fee covers any initial interview and/or other initial information gathering (in person or by phone); review of past records and documentation; administration of tests and scoring and analysis of test results; preparation of a written report; and any feedback session (by telephone or in person) with you or your representative. It also covers other routine communications with you, school, physician, etc. Separate fee will be charged for additional services, such as unanticipated additional testing, preparation of records, attendance at school meetings or other follow-up meetings, or my participation in legal proceedings that you become involved in are additional and are billed separately.
When do I pay for the testing?
Unless other arrangements have been made prior to the testing or you are using your insurance, please pay at least one half of the total fee on or before the initial testing session. The remainder must be paid at the time of the feed-back session. Please make out checks to: David Jacobs, Ph.D.
Can I get my local school district to provide the testing my child needs?
In theory, the school district in which the child attends school is obligated to provide psycho educational testing (but not neuropsychological testing or
psychological testing) for children who need it. Sometimes they provide the testing directly. Other times they will pay the fee for an outside psychologist to do the testing.
Parents have reported several potential problems with having the school do the testing. First, the school district has to agree that the child needs testing, and they are sometimes reluctant. Second, there may be a relatively long delay before they actually get to your child. Third, schools may limit their testing to measuring overall ability (“IQ”) and assessing academic skills such as reading, writing, and math. Other areas of possible concern, such as ADHD, language, memory function, and social and emotional issues may not be covered.
If you would prefer to have the testing done independently, talk to your school psychologist or school Special Ed director. Sometimes the school is willing to pay for an outside testing.
If the school does test your child and you believe further testing (or a second opinion) is warranted, you have the right to have an outside testing done. The school may or may not cover the costs. Feel free to discuss this with us.
What insurance plans do you accept?
I accept the following insurance plans: Blue Shield in-network PPO provider, Aetna HMO and MHN HMO.
Will my health insurance cover testing/assessment?
Most health insurance policies do cover testing if they consider testing to be "medically indicated." "Medically necessary" means either that the problems you or your child have that require testing are the results of a medical issue (e.g., a head injury, Lyme Disease, a seizure disorder) or there is a psychiatric diagnostic issue that cannot be resolved just by interviewing the person. Most insurance companies do not cover testing for educational purposes (as opposed to medical or psychiatric purposes), but occasionally, a policy does provide coverage. If there is a medical or psychiatric issue which the testing will address, the insurance company may provide full or partial coverage.
Our office will call your insurance plan to find out whether testing is covered or if you prefer you may call on your own. Suggested steps for you to follow to find out whether your insurance company will help pay for testing:
1. Call your insurance company and ask whether your child is covered for codes 96101 (“psychological testing”) or 96118 (“neuropsychological testing”). When you call, be sure to specify the reason for the testing (e.g., ADHD, learning disability) and be sure to ask explicitly whether testing is covered for that reason.
2. If you are told that testing is covered, ask if you will need “precertification” or “preauthorization” (i.e., advance approval). Also ask if there is "out of network" coverage.
3. If your insurance company tells you that testing is covered, let me know immediately. It is essential that I contact the company directly to confirm your coverage well in advance of the scheduled test date. The insurance companies sometimes tell the subscriber one thing and the provider something very different. In any case, arranging precertification can take a week or two, and failure to follow the company's procedures may result in the claim being denied.
What if insurance won't cover the costs and I can't afford the fee?
It depends. If you have an HMO you are responsible for only the co-payment. For PPO insurance you are responsible for the balance not paid by your insurance company. Usually this means that you must first meet your deductible, if any, before insurance pays a certain percentage of my fee so you may be responsible for the balance. Note that both PPO and HMO insurance requires a co-pay based on each hour of testing (i.e. a co-pay is required for each hour of testing).
Note that the insurance company may not agree to reimburse all of the services requested. For instance, they may cover personality testing but not psychoeducational testing, or they may cover only a fraction of the hours of testing requested. You remain responsible for paying for any portion of the services that is not covered.
If I am not on the panel of your insurance company, or if you do not follow the procedure above and only seek reimbursement after the testing has been completed, or if precertification is required but has not been obtained prior to the testing, you must pay me directly and submit the bill to your insurance company to have them reimburse you. Under these circumstances, you will be responsible for the full cost of the services, regardless of insurance company fee schedules and regardless of what portion of the fee the insurance company reimburses.
What if the insurance company says it will pay but then denies payment?
Insurance companies often give incorrect information on the telephone. Even “pre-certification” is not a guarantee of payment. A final determination is made only when the claim is submitted. Regardless of any information you or I have been given, either over the phone or in writing, if the insurance company ultimately refuses to cover all or part of the services, you remain responsible for their full cost.
Does submitting my claim to my insurance company affect the confidentiality of the results?
Your contract with your health insurance company may require that I provide it with information relevant to the services that I provide to you. I am always required to provide a clinical diagnosis. Sometimes I am required to provide additional clinical information or copies of your entire Clinical Record. This information will become part of the insurance company files. Though the insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. If you request me to submit a claim to your insurance company, you are agreeing that I can provide requested information to your carrier.
Are there any other circumstances in which my records might not be confidential due to issues related to payment?
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. Either procedure may require me to disclose otherwise confidential information, such as your or your child’s name, the nature of the services provided, and the amount due. If such legal action is necessary, its costs will be included in the claim.
What happens if I cannot keep my testing appointment(s)?
You must call me to cancel your appointment at least 24 hours before your scheduled testing appointment. If you fail to notify me at least 24 hours before your appointment, you will be responsible for paying a $150 no-show fee. Same day cancellations are considered no-shows and will incur the late cancellation $150 fee.
What happens if I am late for my testing appointment?
If you are running late, call me and let know about your expected arrival. However a $75 late fee is charged for arriving more than 30 minutes late.
This list of resources will be helpful in clarifying other questions you might have and in finding tools to further address the issues you or your family might be going thru...Attention Deficit/Hyper Activity (AD/HD)