Insurance Billing and Fee Schedule
FAQs at the Bottom
Dr. Morrison, Dr. Rodriguez-Rivera, and Dr. Caldwell are in-network with BCBS. Dr. Rodriguez-Rivera is in network with Baylor Scott & White plans. All other insurance providers will consider providers as out-of-network. We are NOT Medicaid/Medicare providers and parents cannot be reimbursed for services under these plans when seeking services through Kids BRAIN. We will be happy to file the claim on your behalf, but all fees are due at the time you receive your results. When neuropsychological assessment is requested, most insurance plans will only cover the testing if there is an impacting medical or neurological condition or a history of significant neural insult (head injury, brain tumor, brain infection, seizure disorder, etc.). When assessment is requested for developmental purposes to rule out learning disabilities, attention problems, behavioral control problems, difficulty with developmental delays, or suspected cognitive impairments, reimbursement is much more variable and denial rates are higher. Some insurance plans will consider the extent of testing that is needed to clarify diagnosis and help with intervention planning as "not medically necessary" and will deny all or part of the claim. This results in the expense of testing being the responsibility of the family. You are welcome to use your Health Savings or Flexible Spending accounts. When insurance has denied charges under an insurance contract, the family will only owe the contract rate that the insurance company would have paid or will be responsible for a predetermined total for services that was mutually agreed upon prior to the start of testing. In-network rates for BCBS or BSW apply for in-network patients and itemized out-of-network rates will be discussed explicitly prior to the onset of testing. Dr. Rodriguez-Rivera has extensive experience in providing cognitive rehabilitation for children with acquired head injuries and neurocognitive impairments. This service is available to patients on a cash pay basis. You will know exactly how much you will owe and will not pay a penny more.
Services offered include
Observation If this is requested, attempts will be made to gain access to the child in school (minimum one hour billed). Duration will be dependent on school access and parent request. Observation is not a billable service through your insurance provider. Fees for observation are patient responsibility and will include a mutually agreed upon amount of time and fee schedule prior to the commencement of observation.
Consultation Not every child needs an evaluation. Some have had recent assessment, others have been effectively diagnosed before, and others need a screening process before full evaluation is considered. Some parents would just like to talk about current concerns and have professional insights on what plan of attack makes the most sense. This means an allocation of time to meet in the office, go over birth and developmental history, clearly itemize your concerns, and discuss treatment planning options covering potential therapies, parent training resources, books and materials, bibliotherapy for children, and discussion of educational needs and planning. Billing includes time for office interview and additional time to generate recommendations in a written summary.
Evaluations (Including bilingual assessment) Formal testing with a child usually includes 3 office visits but requires 4 billed dates of service. The first office appointment is for parent interview and typically lasts 45 to 60 minutes. The second appointment is time set aside for formal testing with your child. This appointment may be a short as 1 hour or as long as 7 or 8 hours, depending on the type of assessment and the age of your child. Finally, we will schedule time when testing is complete and information is back from parent and teacher forms to discuss results, interpretation, diagnostic considerations, recommendations, and treatment planning for home and school. Testing is almost always completed in 1 day. Children who stay into the lunch window of 11:30 am or later will need to bring a packed lunch. Snacks and water are provided. Snacks are not always consistent with family dietary restrictions, so bringing special snacks for your child is encouraged if they are gluten, casein, dairy, sugar free, or keep kosher.
Teacher/Educational Feedback All providers would be happy to attend ARD meetings. Dr. Morrison and Dr. Caldwell provide individual teacher consultation when requested. This time is not covered by your insurance provider and will be patient responsibility.
Cognitive Rehabilitation Dr. Rodriguez-Rivera offers cognitive rehabilitation for children with acquired head injuries and neurological impairments. Services are rendered on a cash pay basis.
Do you offer psychological AND neuropsychological assessment?
We sure do!
How is a neuropsychological assessment different from a standard psychological assessment?
Neuropsychology is a specialty of psychology that focuses on determining the relationships between characteristics of the brain and behaviors that are associated with those characteristics. The goal of the neuropsychological assessment is to determine a child's neurocognitive (brain and behavioral) strengths and weaknesses. When consistent and impacting weaknesses are present in a child's profile, diagnostic considerations are made. There are a range of professionals including your physician, a clinical psychologist, neurologist, educational diagnostician, or therapists that can diagnose a problem, but then what? I often find that this is where other assessments end. My professional goal is to be able to tell parents and school staff not only what diagnosis is most appropriate, but also to provide recommendations that are tailored to a single child's strengths and weaknesses in order to guide intervention planning, parent training, and educational planning. This means providing a long list of recommendations for home, school, and the child themselves with the goal of improving quality of life and facilitating access to interventions. In my reports, this means guidance for developing Section 504 plans and IEPs, behavioral strategies for home, resources for parent training and education, books and materials appropriate for the child, and teacher handouts for possible strategies in class.
What does a neuropsychological assessment cover?
Every evaluation is different and is specific to the parent and/or physician concerns. Assessment with younger children often limits which domains can be tested, as assessment measures are designed only for certain age ranges. However, when appropriate, domains include:
How long does a neuropsychological assessment take? Is the testing completed all in one day?
Each assessment is different and is based on the child's age and personal characteristics. However, basic timeframes by age are listed below. All children and evaluations are different. Actual time needed for testing will determine fees for services rendered:
Age 2-3: up to 3 hours
Age 4-5: up to 4 hours
Age 6-7: up to 5 hours
Age 8-12: between 5-6 hours
Age 13-14: between 6-7 hours
Age 15+: between 7-8 hours
Unless significant medical complications are present, all testing is completed in one day. I believe that the most accurate reflection of a child's skills is observed across periods when they are fresh as well as when fatigue sets in. All assessments include regularly scheduled breaks for snacks and to use the restroom. Children testing through the lunch hour remain in the office and eat with me; this offers a nice time for "casual" conversation and interview.
Can parents be in the testing room when the testing is completed?
There is considerable research suggesting that a child's testing scores differ significantly when parents are present. We strive to assess all children separate from their families unless extreme circumstances keep this from being an arrangement that allows for successful observation of skills. Parents are welcome to stay on-site in the waiting room and will be able to see their child any time they leave the room for restroom breaks. Parents are asked to refrain from entering the testing room unless directly requested to do so. Older children, when parents are comfortable with this arrangement, can be dropped off and picked up at the end of the testing day. For very young children (12 to 36 months), portion of the assessment will be completed with the parent in the room.
How do I get started when requesting an evaluation?
The first step is determining whether a neuropsychological or psychological assessment is a good match to your child's needs and your family's desires. Not all children require testing. We may request a simple consultation to get started. This will include a parent interview in the office and then specific recommendations based on concerns. When assessment is needed, the first step is to determine the potential cost of evaluation. This means that we will contact your insurance provider to determine what your plan coverage allows and what your deductible, co-pays, and co-insurance entail. After families have had an opportunity to consider any applicable costs, they can decide if they would like to proceed with scheduling. All assessments include a parent interview in the office, day for testing, and feedback session after testing is complete to receive and discuss the interpretive report. Send an inquiry (on the Home page) to initiate this process.
How do I get in contact with someone at the office?
Just send an inquiry from the home page or call the office. We would be happy to talk with you about your concerns for your child and whether the services offered by Dr. Morrison, Dr. Rodriguez-Rivera, and Dr. Caldwell are a good match for your needs. If we aren't what you are looking for, we would be happy to point you in the right direction regarding other service providers in the area that are a good match for you and your family. Our job is to help, even if we aren't the ones to provide services!