Health Insurance

UPDATE ON MBHP

On November 18, 2024, we received a message from MBHP alerting us to changes in their policies. Effective January 2, 2024, MBHP will implement new "medical necessity criteria," which are the guidelines used by insurance companies to determine whether a specific service or treatment is essential for a patient's health and well-being. MBHP is replacing their current guidelines with a new set that will greatly limit the types of assessments psychologists can offer to MBHP clients. Under these new guidelines, we would not be able to conduct the detailed psychological or neuropsychological evaluations we believe our clients deserve.

Additionally, MBHP’s new system would allow them to retroactively take back payment from us for a completed case based on this new, vague, and overly restrictive criteria set. This practice is sometimes referred to as a "clawback." Because of these changes, our group practice has made the difficult decision to to stop accepting new clients with MBHP insurance for neuropsychological and psychological evaluations, unless this policy is reversed. We are truly saddened that MBHP has chosen to pursue this policy because we greatly value working with MBHP clients and know that your options are already limited.

As you may already know, there are very few testing psychologists in our area who accept MBHP, and these changes will likely reduce that number even further.  We are asking that MBHP to reconsider their decision and are hoping other psychologists as well as members of the public will join us in this request.

We encourage you to check back with us in a few months to see if the policy has changed. You can contact us by phone or email; we will also post any updates on our practice website.  If you wish to take further action to try to push MBHP to reverse this policy change, it may be helpful to contact MBHP’s Member Engagement Center (800-495-0086), your local state representative and/or state senator (you can look them up at this website: https://malegislature.gov/Search/FindMyLegislator), or the Massachusetts Office of Patient Protection (https://masshpc.gov/opp, scroll down to the bottom right of the page and click “submit an inquiry”). Let them know that this policy change is making it harder for you to access the services you need and that you would like to see it reversed. 

We apologize for this situation and the difficulty it causes. Please feel free to reach out if you have any questions or need further assistance.

PRIVATE INSURANCE

We currently do not take any private insurance but can provide you with documentation to help you attempt to get reimbursement from your insurer.

Q. Do you have a waiting list?

A. We no longer keep a waiting list. We open cases whenever we have availability to see you. If you contact us to be seen and we cannot accommodate you promptly, we encourage you to call back in a few months and try again.

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 any reimbursement from the insurer.

If you have MBHP as your MassHealth behavioral health coverage, you cannot pay privately for an evaluation, as it violates our agreement with the insurer.  This is true even if you have MBHP only as your secondary insurance (i.e. you have private insurance or Medicare that pays most of your healthcare costs and MBHP 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.

Q. Do you offer any payment plans/financing?

A. For self-pay, we break up the cost of intake and evaluation into three parts. We require payment for the initial consultation prior to the consultation appointment. If you proceed with testing, we require 50 percent of the total evaluation cost before the first testing session - minus the initial consultation fee that was already collected. We require the remaining 50 percent to be paid prior to our starting to write your test report. For those who need financing, we offer several options through CareCredit as well as payment plan options

through Stripe (e.g., Affirm/ Klarna) . You can discuss these with us or find more

information here: https://www.carecredit.com/go/625BPP/,

https://www.affirm.com/how-it-works, https://www.klarna.com/us/what-is-klarna/.

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

Generally speaking, for all evaluations we offer testing plus a full report. The report includes an appendix containing all your scores and you also receive 1-3 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 what type(s) of testing 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 - minus the initial consultation fee that was already paid - and the balance before we write the report. We take cash, checks, and credit cards.

The evaluation start to finish is billed at a flat-rate of $5000. This rate includes the initial consultation, any and all testing we deem clinically appropriate and relevant to the referral questions, any appropriate collateral contacts, a thoughtfully written report that includes scores and recommendations, and one to three feedback sessions to go over the results with you and/or your child if it is a child case. This flat rate is paid in three parts - see the payment plan section of the FAQ above for the breakdown and details. 

We charge our hourly rate ($250) for other services that are not part of an evaluation, if you request them, such as attending school meetings and writing support letters.

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.

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 their 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