Fees and Insurance – Common Questions and Answers
 

Clinicians affiliated with NWPR/CFMAL are independent and set their own fee schedules.  Thus, fees vary from person to person.  These fees are generally consistent with governmental guidelines suggested by the Health Care Financing Administration (HCFA), reimbursement schedules of most insurance companies, and with those charged by other local mental health practitioners.  Your clinician’s contract with individual insurance companies may require him/her to work within this company’s fee structure.  Portions of fees may be written off to account for these differences.
Please refer to your clinician’s biography page on this website for specific information regarclematisding their fees.

Will My Insurance Help with Costs?

Most health insurances cover psychological and neuropsychological services.  However, almost every policy is different in this regard.  Some require percentage co-pay, while others a flat per-visit co-pay. 
We suggest you contact a customer service representative with your insurance company to see what benefits you can expect.  When calling, we suggest you ask the following questions:

  1. What does my policy cover for outpatient mental health services?
  2. What remains on my deductible, if I have one?
  3. Do I need a special referral to see a psychologist?  If so, by whom?
  4. Is there any special paperwork or authorizations my doctor will need to fill out?
  5. What is my coverage for psychological or neuropsychological testing?

Do You Accept Medicare?

Yes.  Services to mature adults and disabled individuals are an important part of neuropsychological practice.  Any clinician at CFMAL qualified to accept Medicare will do so.  However, there are some important things Medicare recipients should know:

  1. Medicare coverage does not typically cover the entire fee.  After certain write offs the clinician must make, you may still be subject to co-payments and deductibles.  Predicting the exact amount of coverage from Medicare is like reading a crystal ball.   It may not be until we actually receive a payment that we know the extent of your coverage. 
  1. Medicare might refuse to cover some services.  Problems related to memory loss and/or dementia are among the most common examples.  Medicare will pay only for services that it determines to be "reasonable and necessary" under section 1862(a)(1) of the Medicare law. If Medicare determines that a particular service, although it would otherwise be covered, is "not reasonable and necessary" under Medicare program standards, Medicare will deny payment for that service.  Our professional organizations are working with Medicare to solve this problem.  However, it is possible in your case that Medicare might deny payment for services we will need to perform to properly evaluate your symptoms.  Rest assured that we will do everything we can within the law to help you get Medicare coverage for these services, which are likely to include an Initial Diagnostic Interview and Neuropsychological Testing.

Do You Accept Medicaid? (Open medical coupons)

Unfortunately, no.

Persons with Medicaid are required to seek services through agencies contracted to receive State funding in this manner.  In our community, this applies to Lower Columbia Mental Health, and the Center for Behavioral Solutions.

Private practitioners such as those at NWPR/CFMAL are not allowed to provide services to Medicaid recipients, and Medicaid payment will be denied.   Nor will Medicaid pay if they are a secondary insurance.

There are a few exceptions with respect to State-funded insurance programs:

  • Persons with Molina or Community Health Plan of Washington (CHPW) can be seen by NWPR/CFMAL clinicians who have contracted with the State to accept these services.  On the down side, the painful reality is that the rate of payment by these plans is so low (often less than ½ of the clinician’s usual rate), many clinicians must limit the number of Molina/CHPW patients they can take at any one time, taking new patients on a case-by-case basis.  Nonetheless, some of us maintain these contracts out of desire to serve a broad range of clients and as a professional courtesy to referring physicians, especially when the expert diagnostic services we provide are not otherwise available in the community.

  • Persons referred by State agencies (i.e., Labor and Industries, Children Protective Services, Social Security, Department of Social and Health Services) are usually covered by the referring agency.  For example, CPS may send a child or adult for examination and will pay for these services.

Can I use Insurance for Services Relating to Guardianship, Law Suits, Competency, Fitness for Duty, and Public Safety Screening?

Probably not.  These services fall under a category of forensic services.  This means that the services are provided to serve a legal or employment purpose at the request of the third party.  The third party in such cases may include a lawyer, insurance company, judge, case worker, guardian ad litem, school district, government agency, or current or prospective employer.

As described by the National Academy of Neuropsychology, the responsibilities of the neuropsychologist in the context of performing an independent forensic examination differ from those of the clinical examination.   Many people are confused about the difference between clinical and forensic services.  Although they both share many methods in common, these types of services fall under two different “umbrellas.”   

 
UMBRELLA GRAPHIC