Insurance | mysite

INSURANCE

Dr. O’Rourke does not participate in any insurance or managed health care plans and as such, is considered an “out-of-network” or a “non-participating provider.” You are responsible for submitting to and seeking reimbursement from your health insurance provider. In advance of your appointment, you are encourage to contact your health insurance provider and inquire about mental health coverage, deductibles, co-insurance and coverage limits. If you participate in a medical savings account, that may be another option to explore for reimbursement.

When talking to your insurance company, you can ask about the following insurance codes that are typically used in an assessment or consultation:

• CPT 90791 Intake session

• CTP 96136/96137 Psychological and Neuropsychological test administration and scoreing

• CPT 96130/96131 Psychological test selection, integration, interpretation and report writing

• CPT 96132/96133 Neuropsychological test selection, integration, interpretation and report writing

• CPT 90846 Feedback session

Insurance companies will reimburse for some tests but not others so using the above codes can help to clarify what may or may not be covered. In particular, “educational” or “achievement” tests may be part of an assessment so you can specifically ask about their reimbursement.

When talking with your insurance company, you should emphasize that the assessment is a “neurocognitive and psychoeducational evaluation” intended to address the possibility of learning issues, neurocognitive issues, behavioral issues and/or emotional issues. Sometimes insurance companies will want a diagnosis to determine if an assessment is covered. A diagnosis, if warranted, is not made until the end of the assessment. As such, you can ask what diagnoses will and will not reimburse the costs of an assessment. You can also mention your concerns regarding:
• Attention, executive functioning, memory, processing, etc.
• Learning – reading, writing, math, etc.
• Behavior – impulse control, outbursts, etc.
• Emotions or moods – anxiety, depression, etc.

An educational diagnosis such as a learning disability or learning disorder is usually not covered by insurance because it is considered “educational” and not “mental health,” “behavioral” or “medical.”

Finally, make sure who write down all the details of your conversation with your insurance company including the date, time and the name of the person to whom you spoke. Ideally, get that person to send you a link or summary of your coverage policy as it relates to the services you discussed.