Understanding Insurance, Evaluation Fees & Payment Options

If you're considering an evaluation with Brighton Center for Neurodevelopment but are concerned because we do not bill insurance directly, you're not alone.

We hear this question frequently, and we want to help you understand your options before deciding what works best for your family.

Our goal is to make the financial side of the process as clear and predictable as possible.

How Our Fee-for-Service Model Works

Brighton Center for Neurodevelopment is a fee-for-service practice. This means that families pay the practice directly rather than having us bill an insurance company.

Our evaluation fees are established in advance, so you know the cost before the evaluation begins.

After your evaluation, we can provide a detailed superbill that you may submit to your insurance company for possible out-of-network reimbursement.

The amount your insurance company reimburses, if any, depends entirely on your individual insurance plan.

"Covered by Insurance" Does Not Always Mean "No Cost"

Insurance plans vary significantly.

Depending on your specific plan, an evaluation may be:

• Subject to an individual or family deductible
• Subject to copayments or coinsurance
• Covered differently depending on whether the provider is in network or out of network
• Subject to prior authorization or medical-necessity requirements
• Reimbursed according to the insurance company's allowed amount rather than the provider's actual fee
• Excluded from coverage altogether

Because every insurance policy is different, we cannot tell you exactly what your insurance company will reimburse.

Why We Use a Fee-for-Service Model

Our evaluation process is designed around the clinical needs of the child, adolescent, or adult being evaluated.

Our goal is to determine what information is necessary to answer the referral questions, understand strengths and challenges, and provide useful recommendations.

Our evaluation structure and fees are established in advance rather than being determined by an insurance company's reimbursement rules.

For many families, this also provides something valuable: clarity about the cost before the evaluation begins.

Before Making a Decision Based on Insurance

If cost or insurance coverage is making you reconsider an evaluation, we recommend calling the member-services number on the back of your insurance card and asking specifically about your benefits.

You may want to ask:

1. Do I have out-of-network benefits for psychological or neuropsychological evaluation?
2. Is there a separate deductible for out-of-network services?
3. How much of that deductible has already been met?
4. What percentage is reimbursed after the deductible?
5. Are psychological or neuropsychological testing services covered under my plan?
6. Is prior authorization required?
7. Can I submit a superbill from an out-of-network psychologist for reimbursement?
8. Is reimbursement based on the provider's charge or on the plan's allowed amount?
9. Are there any exclusions or limitations that apply to this type of evaluation?

If you are considering another provider specifically because that provider accepts your insurance, it may also be helpful to ask that provider what your estimated out-of-pocket responsibility will be, including deductibles, copayments, coinsurance, and any services that may not be covered.

Payment Options

We understand that evaluation costs matter, and we want families to understand the available options.

Depending on your circumstances, payment options may include:

• Credit or debit card
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• Submission of a superbill for possible out-of-network reimbursement
• Additional financing options as they become available

Our Goal Is Transparency

We do not want anyone to choose our practice without understanding the financial commitment.

We also do not want a family to automatically rule out an evaluation simply because we do not participate directly with their insurance company.