Insurance and Cost information
This lengthy document was developed after years of answering questions from callers to our practice. I hope this helps you find the best and right services for your needs.
Every insurance group plan is unique so each person should carefully study and research their plan. Do not assume that the following tips or suggestions apply to YOUR plan or situation.
The Neuropsychological Evaluation: A neuropsychological evaluation is the "gold standard" in cognitive evaluations for learning disorders, behavior issues or brain injury. Family doctors, pediatricians, neurologists, psychologists, and psychiatrists often refer patients for an evaluation with Dr. Naylor to get a better understanding of a patient's strengths and weaknesses, to rule out a concern, or to find or confirm a diagnosis. Dr. Naylor can also provide ongoing cognitive treatment services.
Dr. Naylor has over 34 years of experience with Wake Forest Medical Center and was head of the Section of Neuropsychology from 2009 to 2012. In October of 2012, she retired from Wake Forest Health Sciences and has since been in private practice.
RATES and CODES: Here are our rates and procedure codes:
Neuropsychological Evaluation: The usual cost of an evaluation: $1800-$2500. Sometimes less testing is appropriate and the cost would be less as well. Here are the procedure codes we use:
90791 - 1 hour interview ($275)
96136/96137 - the first half hour and then multiple additional half hours for testing. ($110 per half hour) (at least 12-16 units are typically required)
96132/96133 the first hour and then multiple additional hours for evaluation, assessment and report creation ($220/hr) (usually 1-4 units are required)
An evaluation results in a comprehensive neuropsychological report that will be discussed at a feedback session 1 to 2 weeks after the testing day.
Dr. Naylor is usually scheduled out about 1 to 3 months. Sometimes we can meet quick needs through creative scheduling.
For those patients paying us directly, we usually take two payments - one at the interview or testing date and the last at the feedback session where the report is discussed.
Cognitive therapy: (customized as required)
97129/97130 - cognitive therapy - $192 per hour billed in 15 minute units. However, if paying out of pocket, Dr. Naylor provides a 25% discount equaling $144 per session.
Cognitive therapy is rarely covered by insurance unless the patient can relate it to a medical condition or incident where pre-approval is often required.
INSURANCE INFORMATION:
Medicare/Medicaid: Since we are not a provider for Medicare/Medicaid, no claim can be filed under those plans. Patients may still come to us, and pay out of pocket, but it will not be a reimbursable medical expense.
Dr. Naylor only panels with Carolina Behavioral Health Alliance which is the mental health services provider for employees insured with Wake Forest University, the Atrium/WFU Medical Center, and related medical offices or networks. Typically those employees have Medcost or BCBS as the insurance, but the insurance card specifies CBHA for mental health services. That would be listed on the back of the insurance card. You can also call CBHA to verify. With CBHA, no authorization is needed for the initial 1 hour appointment, but then test authorization IS required and we routinely file the request for authorization after the interview. Unless you are in the "deductible" plan, your only cost would be your copay amount, which for our 3 visits would total between $0 and $90 dollars.
For all other insurers, Dr. Naylor would be "out-of-network." When seeing us as out-of-network provider, you would pay for our services with cash, check or credit card. We will provide an invoice that you would file with your own insurance company. It would list diagnosis code, procedure codes, dates of service, and hours (units).
Some insurance plans will pay at good levels for out-of-network providers like us. However, you should look at your in-network and out-of-network deductible amounts.
A search on the web shows a few neuropsychologists in the Winston-Salem, Greensboro, High Point area. If you are seeing a doctor at a hospital or medical center, like Atrium Health/WFU or Novant, their internal Neuropsychology may see you and sometimes they take external patients. A search on the web will show neuropsychological offices in Asheville, Pinehurst, Chapel Hill, Durham, Raleigh and Charlotte. Many of those take insurance and Medicare/Medicaid. Sometimes Moses Cone Rehabilitation in Greensboro and Cornerstone in High Point have a neuropsychologist who may be in your network.
Click here for my list of neuropsychologist offices that may take your insurance. The Brain Injury Association of North Carolina has two lists for neuropsychologists: Click here for List 1. For a map and another list, click here, and choose "Neuropsychologists."
Ideas and Issues List: Here is a list of issues regarding insurance:
1) Dr. Naylor does not require a referral from any doctor but your insurance company may require a referral to her even if you are coming out-of-network. In addition, some companies, including some BCBS programs, may require a separate visit and written authorization for the evaluation.
2) If the evaluation is for educational or "personal" purposes, your insurance company may not cover ANY of the cost, whether in-network or not. Please discuss with your doctor whether you have had or current have a medical diagnosis that would satisfy your insurance company.
3) Some insurance companies will allow, on a one-time basis, to treat an out-of-network provider, like us, as an in-network provider. Some possible reasons are:
5) Some insurance companies have a cap on testing hours. An evaluation requires multiple units of the codes listed above.
6) Insurance companies rarely cover treatment, but depending on your medical history and the cause of your situation, your medical doctors may recommend cognitive rehabilitation, and the insurance company might then approve. Contact your insurance's customer advocacy division or your doctor's office.
Please contact me if you have any questions or if I can help.
Regards, Herman Schmid
Office Manager
--
Cecile E. Naylor, PhD
Triad Neuropsychological Service, PLLC
m: 336-464-7032 f: 336-922-3206
www.TriadNPS.com
Dr. Naylor has over 34 years of experience with Wake Forest Medical Center and was head of the Section of Neuropsychology from 2009 to 2012. In October of 2012, she retired from Wake Forest Health Sciences and has since been in private practice.
RATES and CODES: Here are our rates and procedure codes:
Neuropsychological Evaluation: The usual cost of an evaluation: $1800-$2500. Sometimes less testing is appropriate and the cost would be less as well. Here are the procedure codes we use:
90791 - 1 hour interview ($275)
96136/96137 - the first half hour and then multiple additional half hours for testing. ($110 per half hour) (at least 12-16 units are typically required)
96132/96133 the first hour and then multiple additional hours for evaluation, assessment and report creation ($220/hr) (usually 1-4 units are required)
An evaluation results in a comprehensive neuropsychological report that will be discussed at a feedback session 1 to 2 weeks after the testing day.
Dr. Naylor is usually scheduled out about 1 to 3 months. Sometimes we can meet quick needs through creative scheduling.
For those patients paying us directly, we usually take two payments - one at the interview or testing date and the last at the feedback session where the report is discussed.
Cognitive therapy: (customized as required)
97129/97130 - cognitive therapy - $192 per hour billed in 15 minute units. However, if paying out of pocket, Dr. Naylor provides a 25% discount equaling $144 per session.
Cognitive therapy is rarely covered by insurance unless the patient can relate it to a medical condition or incident where pre-approval is often required.
INSURANCE INFORMATION:
Medicare/Medicaid: Since we are not a provider for Medicare/Medicaid, no claim can be filed under those plans. Patients may still come to us, and pay out of pocket, but it will not be a reimbursable medical expense.
Dr. Naylor only panels with Carolina Behavioral Health Alliance which is the mental health services provider for employees insured with Wake Forest University, the Atrium/WFU Medical Center, and related medical offices or networks. Typically those employees have Medcost or BCBS as the insurance, but the insurance card specifies CBHA for mental health services. That would be listed on the back of the insurance card. You can also call CBHA to verify. With CBHA, no authorization is needed for the initial 1 hour appointment, but then test authorization IS required and we routinely file the request for authorization after the interview. Unless you are in the "deductible" plan, your only cost would be your copay amount, which for our 3 visits would total between $0 and $90 dollars.
For all other insurers, Dr. Naylor would be "out-of-network." When seeing us as out-of-network provider, you would pay for our services with cash, check or credit card. We will provide an invoice that you would file with your own insurance company. It would list diagnosis code, procedure codes, dates of service, and hours (units).
Some insurance plans will pay at good levels for out-of-network providers like us. However, you should look at your in-network and out-of-network deductible amounts.
- You may find that you will pay for an evaluation whether you go to an in-network or out-of-network provider.
- You may find that even if you have out-of-network coverage, you may still have a large, separate out-of-network deductible.
- You may find your insurance pays for out-of-network evaluations, but at a lower rate.
A search on the web shows a few neuropsychologists in the Winston-Salem, Greensboro, High Point area. If you are seeing a doctor at a hospital or medical center, like Atrium Health/WFU or Novant, their internal Neuropsychology may see you and sometimes they take external patients. A search on the web will show neuropsychological offices in Asheville, Pinehurst, Chapel Hill, Durham, Raleigh and Charlotte. Many of those take insurance and Medicare/Medicaid. Sometimes Moses Cone Rehabilitation in Greensboro and Cornerstone in High Point have a neuropsychologist who may be in your network.
Click here for my list of neuropsychologist offices that may take your insurance. The Brain Injury Association of North Carolina has two lists for neuropsychologists: Click here for List 1. For a map and another list, click here, and choose "Neuropsychologists."
Ideas and Issues List: Here is a list of issues regarding insurance:
1) Dr. Naylor does not require a referral from any doctor but your insurance company may require a referral to her even if you are coming out-of-network. In addition, some companies, including some BCBS programs, may require a separate visit and written authorization for the evaluation.
2) If the evaluation is for educational or "personal" purposes, your insurance company may not cover ANY of the cost, whether in-network or not. Please discuss with your doctor whether you have had or current have a medical diagnosis that would satisfy your insurance company.
3) Some insurance companies will allow, on a one-time basis, to treat an out-of-network provider, like us, as an in-network provider. Some possible reasons are:
- you can't find a neuropsychologist within a certain distance.
- you can't find a neuropsychologist who will see pediatric patients.
- the neuropsychologist is not experienced for the services you need. (ex: school accommodations, standardized test or board exam accommodations, or flight school evaluations).
5) Some insurance companies have a cap on testing hours. An evaluation requires multiple units of the codes listed above.
6) Insurance companies rarely cover treatment, but depending on your medical history and the cause of your situation, your medical doctors may recommend cognitive rehabilitation, and the insurance company might then approve. Contact your insurance's customer advocacy division or your doctor's office.
Please contact me if you have any questions or if I can help.
Regards, Herman Schmid
Office Manager
--
Cecile E. Naylor, PhD
Triad Neuropsychological Service, PLLC
m: 336-464-7032 f: 336-922-3206
www.TriadNPS.com
