FAQ about Billing and Insurance

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Dr. Maybouer is an in-network provider with Tricare East and BlueCross BlueShield of North Carolina (BCBSNC) and will file your claims with these companies. However, insurance coverage is not exhaustive or limitless. Please see summaries below for additional information about understanding your insurance contract for psychologist covered and non-covered services, copays, deductibles, etc.

The Testing Psych, PLLC offers the option of paying out-of-pocket for an evaluation and any assessment sessions for those families without insurance or whose insurance company does not offer benefits for services.

For instance, if you are being tested for ADHD, your insurance coverage may not cover academic testing such that you could rule out a learning disability. However, you can still opt to add in an academic testing, but those tests would have to be billed and paid for at personal expense rather than billed to insurance. Assuming your insurance covers psychological testing, the additional direct out-of-pocket cost to add in academic testing is approximately $500.

Every psychological evaluation is custom tailored and the total is dependent on the questions that must be answered and the complexity and of time spent at an hourly rate. Charges include intake and clinical interviews, test administration, scoring, interpretation, report writing, and  follow up visits for feedback and recommendations. A detailed and narrative report of the evaluation, which includes recommendations, will follow. 

As previously noted, some types of psychological assessments may be considered a medical (not mental health) benefit and often insurance carriers will provide coverage for reimbursement, and other types are not eligible for coverage. No health insurance companies I am contracted with cover educational testing, even if “prescribed” by a medical provider. They are very clear that school-related assessments are not considered “medically necessary” as covered by health insurance, and thus considers it to be an educational need to be addressed by school systems. Read more about the difference between educational “eligibility“and “medically necessary” billing requirements here.

In addition, even  if you do have some testing coverage, insurance companies may also limit the number of hours allotted for assessment or mandate or deny the use of specific tests.  And as always, even with an authorization and verification of benefits, policies are explicit that there is no guarantee of coverage, and the client is ultimately responsible for all costs. 

If a client is hoping to use on insurance, please contact your insurance company about your specific policy and coverage. An outline of suggested questions is available here.

INSURANCE: 

As noted, professional services are rendered and ultimately charged to you, not your insurance company. Please understand that the contract is between you and your insurance company and payment for services is your responsibility. Each company negotiates different benefits and clients are responsible for understanding their individual policies and ultimately financially responsible for all costs.

CO PAYMENTS  AND DEDUCTIBLES:

Your health insurance policy may state that you pay be required to pay a co-payment for appointments, and you may have an individual or family deductible you are responsible for. Dr. Maybouer has a legally binding contractual agreement with the health insurance carriers to apply deductibles and collect all co-pays on the date the services are rendered. A valid credit card is required to be kept on file for all co-pays, deductibles, etc. 

In order to satisfy contractual agreements with health insurance companies and accept your insurance or to establish a fee-for-service contract,  all clients are required to leave a valid open credit card with a signature on file, authorizing Sara Maybouer, PhD, PLLC. to bill that card for the co-payment, payments, and late or no-show fees. Credit card information will be stored in a professional, off-site, secure credit card system called Stripe. 

Please keep in mind that even if you are using insurance, your case may require services that are not covered, which are to be paid in full at the time of service. Uncovered services can include achievement testing, consultation with other professionals, interviews, writing letters, phone calls, travel time, and school observations/IEP meetings. Your card will be charged for any outstanding balances. If paying fee-for-service, a 50% deposit is due before scheduling test dates; the remaining balance is due before any results are presented.

Dr. Maybouer’s office  requires 48-hour notice if you must change or cancel an appointment. In the event that you must cancel your intake or feedback appointment without providing sufficient notice, your credit card on file will be billed $50. If you must cancel your testing appointment without providing sufficient notice, your credit card on file will be billed $150.