neuropsychologist evaluation - Ins didn't pay enough

[can'tstandit]

HI Blue - my son had a full neuropsychologist evaluation on June 1 at a cost of $3200!! Ouch - the dr's ofc said that insurance would cover it, so I went ahead with it.

However, I just saw an EOB from the insurance company (Aetna Managed Care) and they only paid their negotiated cost ($70) for a regular visit!

The ins co says I'm only responsible for the co-pay, but I can't imagine that the dr's ofc will be happy with that. Will I have to pay the rest??

I see payment plans in my future!!

Thanks,
Ibis

 

[OTE]

well I'm not the insur expert but I have had success in this area. first thing I do is go back to the evaluation office and ask them to re-bill changing the codes. eg this was NOT one visit, it was a series of visits over many hours. so they need to bill it as a series of visits, not one vist. they also need to put service codes on it to indicate testing, not regular visit if those are higher paying items.

Also.. since the purpose of this is the input to the IEP if Aetna doesn't pay it I'd ask the SD to pay it. My SD paid for evaluations that my insur didn't cover. I know this may be a harder sell in some SDs but I'd send them a letter and make a case for it. let them pay the Dr directly if they want to. But show them that it was done by a professional for the purpose of the IEP.

 

[bigblueagain]

sorry just now getting a chance to see this post. Most managed cares DO NOT cover neuropsychologist evaluations I hate to let you know. They are in the gray area of whether it is a psychiatric evaluation or a medical one. Therefore most have to be preapproved and go thru much red tape to get approved. IF the doctors office told you insurance would cover it, (AND please I hope you have the date and name of WHO told you that) and if they are a managed care provider, then yes, you should be only responsible for the copay. The usual arrangement is with managed care providers that things that they do that they do not get approved on the front end and then are not covered they do have to write off. Keep that EOB and personally I would leave it go for now if the provider is not balance billing you. If they are then we will go to the next step. BLUE

 

[can'tstandit]

Thanks OTE and Blue - the doctor's secretary called the insurance company and supposedly got it approved. I haven't seen any balance billing yet, but we'll see. I really need to get back and see the neuropsychologist for some therapy, but I'm afraid to call!

Thanks - I'll wait and see what happens!
Ibis

 

[LAURA]

My HMO payed 100 % for Joshua's neuropsychologist evaluation. Our peds Dr. ordered it. And it was taken care of. I hate HMO's by the way.

Laura

 

[OTE]

If you need therapy don't hold off waiting for insur. Call and make the appointment. waiting isn't likely to make it better. and I'm sure the doctor understands and can make some sort of pmt arrangements if necessary.

 

[bigblueagain]

again I would only go ahead and set up the appointment if you don't need a referral. With Aetna's managed care I have known of them to be very strict about going without the proper referral. Especially for the mental/nervous visits. There are usually limits of number of visits and pay amounts.
blue

 

[Christine]

They will rebill with different codes to your insurance, and if they told you it was covered before you agreed, they will be responcible for the unpaid balance minus your co-pay. Doctors offices know ahead of time what they can bill for and how much.