1. What are the purposes of neuropsychological assessment?
Neuropsychological assessment has two main purposes. First, it helps us to clarify diagnoses and describe more specifically the effect of the given diagnosis on an individual's cognitive and behavioral functions. Second, it helps us to develop plans for helping both adults and young people to cope with the demands of work, school, and the social world.
2. How long does neuropsychological assessment take?
We conduct neuropsychological assessment at three levels: Full neuropsychological evaluation, neuropsychological consultation, and brief neuropsychological screening.
- A full Neuropsychological Evaluation typically ranges from 8 to 12 hours long. Six to 8 of these hours are typically consumed by direct, face-to-face testing with the patient; another two to four hours are required for scoring and writing up reports; and another hour to two hours are typically involved in discussing the results and recommendations with the patient and family.
- In some situations, where the problem is fairly clearly defined and especially when previous testing has been done, the neuropsychologist is able to restrict himself to a streamlined, 5-6 hour Neuropsychological Consultation.
- In still other situations, when the neuropsychologist is being asked to rule out a very straightforward diagnosis, such as dementia, Neuropsychological Screening can take place over as little as 2 to 3 hours.
3. Will my insurance plan cover a neuropsychological evaluation?
Insurance coverage varies according to the nature of the patient’s condition and the type of insurance plan. With developmental and acquired conditions that are clearly neurological in nature, such as traumatic brain injury and epilepsy, there is very often at least partial insurance coverage, and sometimes substantial coverage, for a neuropsychological evaluation.
However, with disorders that are assumed to be more strictly cognitive and behavioral in nature, or when there is no obvious history of neurological illness, such as Attention Deficit Hyperactivity Disorder and Learning Disabilities, insurance coverage is less likely.
4. Does the Neuropsychology Service handle insurance preapprovals for neuropsychological evaluations?
Often, your insurance company requires your physician to obtain insurance preapprovals for neuropsychological evaluation. It is your responsibility to contact your
insurance provider and ascertain this information. However, we can help you and the referring physician obtain precertification by supplying letters and completing medical necessity forms.
When you speak to the support staff within your insurance plan, you can inform them of the procedure or CPT Codes for neuropsychological testing, which are 96116, 96121, 96136, 96137, 96132, 96133. You can also inform the support staff of the patient's likely diagnosis in your effort to determine whether or not there is insurance coverage. If the patient has any type of medical diagnosis, such as stroke, epilepsy, heart disease, traumatic brain injury, etc., it is critical that you emphasize the primary role of this disorder in the patient's current cognitive and psychosocial concerns. In our billing statements for testing, we will of course do the same.
5. What do I say if my insurance company asks for Dr. Preston's, Dr. Lebowitz's,
Dr. Roseman’s, Dr. Coulehan's Dr. Miranda’s or Dr.Mordhorst’s provider
number?
Tell your insurance representative that Dr. Preston, Dr. Lebowitz, Dr. Roseman, Dr. Coulehan, Dr. Miranda and Dr. Mordhorst do not bill as individual providers and
therefore do not have provider numbers. The billing should be handled as an Outpatient Service provided by Stony Brook University Hospital, and the Hospital will
have a provider number that is known to your insurance company.
6. How is billing for neuropsychological assessment handled?
For patients with clearly defined medical disorders, and situations in which you have clear insurance company precertification, we ask that you provide a standard insurance co-pay for each visit. We also ask, however, that you sign a guarantee of payment, indicating that you will make up whatever your insurance company does not pay. Please note that you are responsible for co-pays, deductible and co-insurances).
For patients with developmental attention and learning problems such as ADHD, Reading Disorders, etc., where insurance coverage of any type is less likely, we ask
that families provide payment in full for each session prior to the initiation of testing. Please note that a portion of the hours billed are to cover the cost of scoring and writing the extensive report (See FAQ#2 above).
7. If I am unable to pay the full fee for neuropsychological assessment during the course of the evaluation, is it possible for me to work out a payment plan or reduced fee?
The Neuropsychology Service is not authorized to offer reduced fees or payment plans. Stony Brook University Hospital provides a Financial Assistance Program for families with limited income.
Families seeking financial help should call the Program at 631-444-4331.
