Reply to Please help me not screw up in asking about coverage for neuropsych eval

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Reply to "Please help me not screw up in asking about coverage for neuropsych eval"

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[quote=Anonymous]After discussions with our son's life-long pediatrician and having a 45-minute phone consultation with a reputable neuropsychology practice, my husband and I have agreed that we want to schedule a neuropsychological evaluation for our son. It will cost $3500 and if we have to pay for the entire thing out of pocket, we will. However, I want to see if my insurance will cover any of it. I have the 200-page Group Contract that details covered benefits and exclusions.

I couldn't find anything in the contract that excludes coverage under the Exclusions section, and under the Benefits section, within the Mental Health and Substance Abuse Services subsection I found "Outpatient Psychological and Neuro-Psychological Testing for Diagnostic Purposes."

Because the practice does not take insurance, if I do receive any coverage it would be considered out-of-network, meaning I'd have to satisfy my deductible first. Fine. And I also understand that I'll have to submit any claims myself.

In talking with the practice, they gave me a specific procedure code (#96101) and told me to call my insurer (CareFirst) and ask if "I have out-of-network coverage for neuropsych evaluation billed under 96101."

Seems simple enough, but does anyone have any advice or words of caution before I make the call? I don't want to say the wrong thing or just accept a simple "no." Also, do I just call the "Member Service" number on the back of my card or should I call the number listed for "Mental Health/Substance Abuse"?

Thanks for humoring me. [/quote]

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