A comprehensive neuropsychological evaluation is an involved and thorough process that includes a detailed interview, many hours of formal testing, analysis of data, communication with other professionals and or schools, report writing, and follow-up meetings to review results. The result is information that can help you to understand yourself or your child at the current time but can also be used in work with other professionals and school for years to come. It is an investment in your child or yourself. Most evaluations are paid for "out-of-pocket" and payment is requested at the time of the first testing session unless other arrangements are made. For specific fees, please contact Dr. Morton.
In some cases, insurance can be used to cover all or part of an evaluation. It is important to note that most insurance plans have exclusionary criteria in which they will not cover evaluations that are determined to be primarily for educational or legal purposes or to evaluate ADHD. Dr. Morton is a participating provider for Blue Cross/Blue Shield HMO plans and Tufts Health Plan. For HMO plans, coverage for Neuropsychological and Psychodiagnostic testing is determined by the insurer on a case-by-case basis. In some cases, the insurer will agree to cover only a portion of the evaluation, in which case the remainder may have to be paid for out of pocket. Dr. Morton is not a participating provider for BCBS PPO plans but these plans do not require prior authorization and will reimburse members directly according to the allowed benefits of the specific plan.
In many cases reimbursement can be obtained through out-of-network benefits for other insurance carriers with which Dr. Morton is not a participating provider. If you are insured through a company other than BCBS or Tufts, speak with your insurer about the out-of-network policy for your specific plan. We are more than happy to answer any questions you may have about insurance coverage or to help guide you through this process, including providing you with paperwork necessary to seek reimbursement from the insurer. Please feel free to contact our office at any time.
A note about insurance reimbursement: For insurance plans in which Dr. Morton is not a participating provider, the insurer will reimburse according to what they call the "usual and customary" rate, which refers to a specific rate set by that insurance company. Despite using the term "usual and customary" it is important to note that it is much less than the rate charged by most providers. Therefore, when an insurance plan states, for example, that it will reimburse 80%, this refers to 80% of the usual and customary and may be a much smaller percentage of the actual cost of the evaluation.