Even though I am not in-network with any insurance companies, it does not mean I cannot see you and that you cannot be reimbursed (at least partially) for my services. Many insurance plans provide some coverage for providers who are not in-network (some reimburse up to 80%). Below I offer some tips that may assist you in talking with your insurance provider. (Please note that I cannot guarantee reimbursement. This is between you and your provider.)
1) Call your insurance company’s Behavioral Health representative, and ask them whether they provide reimbursement for “OUT OF NETWORK” “NEUROPSYCHOLOGICAL TESTING.” If so, ask them the specific amount or percentage (and if there is a deductible).
2) If they ask you the “CPT CODE” for this procedure, tell them the code is “96118”. This is the medical procedure code designated for Neuropsychological Testing. Yes, your insurance provider will expect you (the patient) to know this. (!) This past year this CPT code was changed to now include four CPT codes (96136, 96137, 96132, and 96133).
3) Confirm whether or not they require “PRIOR AUTHORIZATION” or a “PROVIDER REFERRAL.” Some insurance companies will not reimburse any out-of-network providers/procedures unless your Primary Care Provider (PCP) requests the service first. Neuropsychological testing is an important procedure because it will result in a clarified diagnosis that will best inform your medical provider (i.e., psychiatrist) whether medication may be warranted and, if so, it will assist them in making a well-informed decision about what kinds of medication are appropriate. If you want to be reimbursed, be sure to get your insurance company's approval before we begin. This way, when you submit your invoice after the evaluation is complete, you will not be told that you never got their permission (which will result in a denied claim).
4) They will likely ask you for my license number, NPI number and address:
My license # is: 015307 (New York State)
My NPI # is: 1760543441
My address: 1619 Third Avenue, Suite 202 NY NY 10128 (Old address, in case they have not updated me in their system: 114 East 90th Street, Suite #1A, NY NY 10128)
I hope this information is helpful to you. It is important to me that you are able to receive as much reimbursement as possible for this very important evaluation.
Contact me at 718-579-5476 if you have any questions.