Do You Accept Insurance?

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​McDermott Psychological is an out-of-network provider and does not bill insurance companies directly. Families are responsible for paying the evaluation fee to the practice.
 

After full payment, you will receive a detailed superbill that can be submitted to your insurance company for possible out-of-network reimbursement.

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Can My Insurance Company Reimburse Me for an Evaluation?

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Possibly. Some health plans include out-of-network benefits for psychological testing, while others do not. The amount reimbursed may depend on your deductible, coinsurance, the services provided, your plan’s allowed amount, and other provisions of your policy.
 

Because coverage is determined by the individual insurance company and health plan, McDermott Psychological cannot guarantee that any portion of the evaluation fee will be reimbursed.
 

What is a Superbill?

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A superbill is a detailed document containing information about the services provided, the clinician, relevant billing codes, and the amount paid. It gives your insurance company the information needed to evaluate an out-of-network reimbursement request.
 

A superbill is not a guarantee of payment. Your insurance company will determine whether the services are covered and how much, if anything, it will reimburse.

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Will I Have to Navigate Insurance on My Own?

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You are responsible for confirming your benefits and submitting your reimbursement request, but you do not have to begin the process without guidance.
 

McDermott Psychological will provide the documentation needed for claim submission and can offer a straightforward guide to the questions you may wish to ask your insurance company. Your insurer remains the final authority regarding coverage, reimbursement, required documentation, and claim decisions.
 

What Should I Ask My Insurance Company?

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Before scheduling, call the member-services number on your insurance card and ask about your out-of-network benefits for psychological testing.
Questions may include:

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• Does my plan include out-of-network benefits for psychological testing?

• Do I have an out-of-network deductible?

• How much of that deductible has already been met?

• What percentage of the allowed amount will the plan reimburse after the deductible is met?

• Does the plan require preauthorization?

• Does the plan require a referral?

• Are there age limitations or exclusions for psychological testing?

• Is a diagnosis required for reimbursement?

• What documentation must be submitted with the claim?

• Is there a deadline for submitting an out-of-network claim?

• How can I obtain the necessary claim form?

• Where and how should the claim be submitted?

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It may be helpful to record the date of the call, the representative’s name or reference number, and the information provided.

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Which Billing Codes Should I Mention?
 

Your insurance company may ask which Current Procedural Terminology, or CPT, codes may be used for the evaluation. Codes associated with services provided by McDermott Psychological may include:
 

• 90791 — Psychiatric diagnostic evaluation

• 96130 and 96131 — Psychological testing evaluation services

• 96136 and 96137 — Psychological test administration and scoring

 

The particular codes used will depend on the services provided. Dr. McDermott can confirm the anticipated codes for your evaluation so that you can discuss them with your insurance company.
 

Providing these codes allows the insurer to look up the relevant benefits, but it does not guarantee coverage or reimbursement.
 

Do I Need a Referral?
 

You do not need a referral to contact McDermott Psychological or submit an evaluation request.
 

Your insurance plan may nevertheless require a referral from a pediatrician or another healthcare provider before it will consider an out-of-network reimbursement request. Ask your insurance company about this requirement before beginning the evaluation.
 

Does My Insurance Company Require Preauthorization?
 

Some plans require prior authorization for psychological testing. Others may request information about the proposed services before determining whether they are eligible for reimbursement.
 

If preauthorization is required, ask your insurer:
 

• Who must request the authorization?

• What information or documentation is needed?

• Whether authorization must be completed before the initial appointment

• Whether approval guarantees reimbursement

• How long the authorization remains valid

 

Authorization does not necessarily guarantee payment, so ask the representative to explain any additional requirements.
 

When Will I Receive the Superbill?
 

A detailed superbill is provided after full payment. You can then submit it to your insurance company using the process required by your plan.
 

Processing times and requests for additional information vary by insurer. Contact your insurance company directly if you have questions about the status of a submitted claim.
 

What If My Plan Does Not Include Out-of-Network Benefits?
 

If your plan does not provide out-of-network coverage—or if your deductible has not been met—you may be responsible for the complete evaluation fee without reimbursement.
 

Dr. McDermott will explain the recommended evaluation process and applicable fee before the evaluation is scheduled, allowing your family to consider the anticipated cost before deciding whether to proceed.
 

Can McDermott Psychological Guarantee Reimbursement?
 

No. McDermott Psychological can provide appropriate documentation and general guidance, but reimbursement decisions are made entirely by the insurance company according to the terms of your health plan.
 

Information provided by an insurance representative is also not always a guarantee of payment. Ask whether you can obtain confirmation of your benefits or authorization in writing.
 

Review Evaluation Fees and Payment Information
 

Evaluation fees vary according to the type of evaluation and the child’s age. The fee generally includes the initial parent meeting, individualized assessment, relevant record review, consultation with other professionals when appropriate, a feedback meeting, and a written report with personalized recommendations.
 

View Fees and Payment Information →​

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Questions About Scheduling?
 

Submit an evaluation request to tell Dr. McDermott about your concerns and learn about the recommended process, current availability, and applicable fee.
 

Reaching out does not commit your family to scheduling an evaluation.