Health Insurance

As of 1/1/23, we will be beginning the transition off all insurance panels, by no longer accepting or waitlisting anyone who plans to pay with insurance. We are finding it increasingly unsustainable to provide the comprehensive type of assessments we offer within insurance parameters. 

Q. What if I am currently waitlisted for an evaluation?

A. If you are currently waitlisted for an evaluation, we will be reaching out to you to see if you want to continue to wait. We hope to see everyone on our waitlist who still wants to be seen, before we terminate with insurance. Please respond to us promptly when we contact you regarding your intentions, so we can get an accurate understanding of how many people are still on our waiting list and we can attend to everyone as promptly as possible.

Q. Will my insurance reimburse me if I pay you out of pocket?

A. If you have private insurance, you can only receive reimbursement if you have a PPO plan, and different plans have different policies. We cannot guarantee you will receive reimbursement or how much, but we are happy to provide you with a superbill you can submit to your insurance.

If you have an HMO plan with a private insurer, you will not receive reimbursment from the insurer.

If you have MassHealth, we cannot accept any out of pocket payments from you at this time, as it violates our agreement with the insurer.  This is true even if you have MassHealth only as your secondary insurance (i.e. you have private insurance or Medicare that pays most of your healthcare costs and MassHealth only picks up your copays).

Q. I have a PPO health insurance plan with an insurance you do not take, can I have the plan pay you directly?

A. We do not accept direct payment from any insurers for whom we are not in network. You would be responsible for payment to us but we can provide you with an invoice to submit to your insurance company. You may be able to get some of the cost of the evaluation reimbursed by your PPO plan after the fact but you should call them before we get started to doublecheck.

If you are paying privately for testing, we work on a flat rate model with a variety of packages and components based on your clinical needs, the purpose of the evaluation, and your preferences.

Generally speaking, for all evaluations we offer two different options, testing plus a full report, or testing plus a briefer summary. In both cases, you receive an appendix containing all your scores and 1-2 sessions in which we go over the results and recommendations with you.

We would discuss with you at the conclusion of the initial consultation session which testing package we would recommend based on your situation and needs. We have found that for self-pay, the flat rate model works the best, as there are no surprises for you as to cost as we go along. We ask for half the testing fee at the first testing appointment and the balance before we write the report. We take cash, checks, and credit cards.

The initial consultation is $300. 

Testing packages range from $3000 to $4000, depending on what is involved.

Fees for legal cases are higher, and we typically work using a retainer structure. We are happy to discuss these rates with you if your case is legal, rather than clinical.

Dr. Rutherford is also licensed in New York State and can provide services there via telehealth. These services are priced higher due to the additional work required to offer this option and keep abreast of NY practice and policies, but are reasonable by NY standards. If you are a potential client in New York State, rates will be discussed with you before any services are undertake

You have the right to receive a “Good Faith Estimate” explaining how much your healthcare services will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance (i.e., paying out of pocket) an estimate of the bill for healthcare items and services.  

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare items or services. 

Make sure your healthcare provider gives you a Good Faith Estimate in writing at least 1 business day before your healthcare service occurs. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. 

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. 

Make sure to save a copy or picture of your Good Faith Estimate. 

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises