Getting reimbursed for a self-pay evaluation

The Process

Five steps, most of them short

1. Check your out-of-network benefits before you start. Call the member services number on your insurance card and ask the questions below. This ten-minute call tells you what to expect back, and whether your plan requires anything in advance.
2. Complete your evaluation and pay at the time of service. Payment is due in full to us; reimbursement then happens between you and your insurer.
3. Receive your superbill from us. A superbill is an itemized receipt built for insurance submission: service codes (CPT), diagnosis codes, our provider and practice identifiers (NPI, tax ID), dates of service, and amounts paid. It contains everything insurers require to process an out-of-network claim.
4. Submit the claim to your insurer. Most plans accept out-of-network claims through the member portal on their website or app, usually as a simple upload of the superbill with a short claim form. Plans set deadlines for submission, commonly 90 days to a year after the date of service, so submit promptly.
5. Receive reimbursement directly from your plan. Payment typically arrives as a check or deposit at your plan's out-of-network rate, after any out-of-network deductible is met.

Before You Call

Questions to ask your insurance company

When you call member services, ask these five questions and write down the answers:

• Do I have out-of-network benefits for outpatient mental health services?
• What is my out-of-network deductible, and how much of it have I met this year?
• After the deductible, what percentage of the allowed amount do you reimburse?
• Is preauthorization required for psychological or neuropsychological testing?
• How do I submit an out-of-network claim, and what is the submission deadline?

If they ask what services to look up, the relevant service categories are the diagnostic interview and psychological or neuropsychological testing. Your superbill will list the exact codes.

What We Provide

Everything the claim needs

With every completed evaluation, you receive a detailed superbill on request, prepared for direct submission. Before services begin, you receive a Good Faith Estimate of expected charges, as required under the No Surprises Act. If your insurer has questions about the codes or documentation on your superbill, we are glad to clarify what was provided.

What we cannot do is submit the claim for you, negotiate with your plan, or guarantee reimbursement. Whether and how much a plan reimburses depends entirely on your specific benefits. Most clients with out-of-network mental health coverage recover a meaningful portion of their evaluation cost; some plans reimburse little or nothing.

MedicareWe are unfortunately unable to provide services to individuals covered by Medicare at this time, including Medicare Advantage plans, and including on a self-pay basis. If you are covered by Medicare and looking for these services, please email admin@godfreyadvancedpsych.com and we will connect you with local providers who are able to help.

Medicaid also follows different rules than commercial insurance, and superbill reimbursement generally does not apply. If you are covered by Medicaid, please contact us before booking so we can talk through your options.