Fees and Charges
Fees are discussed directly on phone contact. Fees are on an hourly basis for psychotherapy and consultation. Fees for assessment are set by the specific tests administered and the time required.
Parents are responsible for the costs of assessments. Then Gifted Resource Center will help facilitate reimbursement by insurance companies, but, except for Blue Cross of RI (and other Blue Cross companies that allow cross border referrals), we are not providers for insurance companies. This means parents will have to negotiate with their insurance company (with the exception of BCRI) to see what is required to get payment. If parents have a policy with PPO coverage, claims may be paid.
Parents are also responsible for finding out what the insurance company will cover, if referrals from primary care physicians are needed or if the policy has a managed care mandate.
Generally, insurance companies will only pay for services if a mental health diagnosis is given to the child. Thus, for IQ and achievement testing, in most cases, insurance will not cover the cost.
Insurance companies will also not cover any testing done for the purpose of education. Thus, those tests that are academic in nature are not covered in a battery of tests even if those tests are necessary for diagnosis. Insurance will not cover testing for learning disabilities.
Insurance may cover testing to assess problems that result from underlying social and emotional issues, to make a diagnosis when there is confusion what is causing the problems (differential diagnosis), to assess brain functioning when dysfunction is suspected, or to assess functioning when areas of daily life are being affected. Each insurance company has a different set of regulations about what they will and will not cover, what is required to get coverage and how much testing they will pay for. Insurance also will pay only a set amount per hour for testing and there is often a limit on the number of hours covered. Thus, parents will be reimbursed the fee per hour times the number of hours allowed minus the co-pay and deductible amounts for the testing.
Payment is required with a deposit before testing is started and the balance is due at the time of feedback when the report is ready.
Fees and Charges for Psychotherapy
Fees are based on a 45-50 minute session for individual, family and parent sessions. On occasion longer sessions are conducted, for example, a child is seen and then the parent is seen. Insurance companies may cover fees when a mental health diagnosis is given to the child. Currently many insurance companies have limitations on the number of visits allowed per year. This will change on 1/1/2010 when the mental health parity law takes effect, though there will likely still be other limitations imposed.
Fees and Charges for Consultation
Fees for consultation are charged on an hourly basis and include costs of face-to-face interaction, time on the phone, time reviewing reports, report writing time. Most of these costs are not insurance reimbursable.