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 left Wake Forest Health Sciences and began her private practice.
RATES and CODES: Here are our rates and procedure codes:
Neuropsychological Evaluation: The usual cost of an evaluation: $1900-$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 soon after the testing day.
Dr. Naylor is usually scheduled out about 2 to 3 months. Sometimes we can meet quick needs through creative scheduling.
For those patients paying us directly, we take one or two payments at any of the three appointments: the interview, the evaluation, or at the feedback appointment where the report is discussed. A 3% fee applies for credit card payments.
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 for continuing care.
Cognitive therapy is rarely covered by insurance unless the patient can relate it to a medical condition or incident. Pre-approval is often required in those situations.
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.
We are not paneled with any insurance company. Therefore, Dr. Naylor would be "out-of-network" for your insurance. When seeing us as an out-of-network provider, you would pay for our services with cash, check or credit card (3% fee). 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 their own payment level for out-of-network providers like us. However, you should look at your in-network and out-of-network deductible amounts.
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 list 2, 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) 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 left Wake Forest Health Sciences and began her private practice.
RATES and CODES: Here are our rates and procedure codes:
Neuropsychological Evaluation: The usual cost of an evaluation: $1900-$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 soon after the testing day.
Dr. Naylor is usually scheduled out about 2 to 3 months. Sometimes we can meet quick needs through creative scheduling.
For those patients paying us directly, we take one or two payments at any of the three appointments: the interview, the evaluation, or at the feedback appointment where the report is discussed. A 3% fee applies for credit card payments.
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 for continuing care.
Cognitive therapy is rarely covered by insurance unless the patient can relate it to a medical condition or incident. Pre-approval is often required in those situations.
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.
We are not paneled with any insurance company. Therefore, Dr. Naylor would be "out-of-network" for your insurance. When seeing us as an out-of-network provider, you would pay for our services with cash, check or credit card (3% fee). 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 their own payment level 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.
- Your insurance company may allow a one-time in-network allowance to see Dr. Naylor if she is the only qualified neuropsychologist within a certain distance.
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 list 2, 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) 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
