No - claims cannot be processed without a diagnosis code. If you decide you will file your services with your insurance company, please be aware that any diagnosis made will become part of your child’s permanent insurance record. The only way to keep the diagnosis code from your child’s record is to pay out of [...]
If you are looking to be seen in person (in our office) then you will need to check with your insurance carrier if they will accept North Carolina providers as “in-network” for your specific policy. Due to professional licensing restrictions, we cannot at this time provide telehealth appointments with clients who are calling from another [...]
What this means is that we cannot submit claims to your insurance carrier on your behalf. For therapy, we can provide a receipt which can be used for you to submit as a claim. For assessment, once the final report is complete, we will provide you with a comprehensive superbill for you to submit as [...]
Sometimes insurance policies specify that clients can only see a select group of approved providers. Your insurance carrier can provide details as to why your particular plan does not include all providers within the paneled network.
Genesis Clinical Services is on the panel with Blue Cross Blue Shield and Medcost, with some providers also individually approved for Aetna. We are approved as an Out of Network Preferred Provider for Tri-care.
After the initial appointment, the psychologist can help complete the forms or provide a letter of medical necessity based upon background data provided and the initial appointment discussions only. We cannot ethically cannot provide diagnosis codes for the client after this initial meeting, but can provide suspected diagnoses which we recommend testing for.
Preauthorization denials or partial approvals are able to be appealed within a certain time frame. This appeal must come from the client or the client’s responsible party (parent or caregiver). Genesis can provide support by sending any clinical information, and a provider recommendation of testing coverage based upon the background information and appointments which have [...]
For minors, any testing considered “educational” to test for learning disabilities, attention or achievement level will typically not be covered unless this testing is part of a group of tests looking at other psychological conditions. Since the public school system can evaluate for educational issues, insurance companies may consider any private educational testing not “medically [...]
If you intend to submit claims to your insurance carrier and your policy has a preauthorization requirement, then yes this needs to be completed before any testing can occur. Genesis can submit this for you as it will need clinical information and coding. We will provide you a form to gather information of what is [...]
Preauthorization may be required by an insurance company for assessments. This is determined by the coverage guidelines of individual policies. If pre-authorization is required and not obtained, insurance companies will deny any claims filed so it needs to be completed before any testing is to occur. Pre-authorization is not a guarantee of insurance reimbursement.