Insurance & Assessment Coverage FAQs

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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 occured. Once you have the appeal started, please contact us to coordinate needs. 

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 necessary” and deny claims. If your testing will be purely educational in nature, we strongly recommend you call and discuss the client’s case with your insurance company before starting the assessment process, to confirm what will be covered. 

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. 

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 needed and who we will submit it to. 

Since mental health insurance can be subjectively reviewed by your insurance carrier, we legally cannot take responsibility for determining your coverage should the final result be different from the original estimate. As a provider we also are limited in our access to your specific policy information, and are not provided details such as family deductible and if our providers are considered “in-network”. 

Insurance companies have teams of specialists who will review and approve coverage for assessment services only once the assessment is complete and the resulting diagnosis is provided. They do not consider psychological testing “medically necessary” for “experimental” or “investigational” diagnoses. Diagnoses considered “experimental” or “investigational” vary depending on the insurance carrier and are subjective to the review team they have in place. 

 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 state. 

The report is considered part of the client’s file.  Client files for an adult are retained for 7 years.  Client files for a minor are retained for at least three years past the age of majority (age 18), or seven years, whichever is longer.

Once the feedback session is complete, within a few business days you will receive a Diagnosis and Treatment Plan which is 1-3 pages long.  This is a summary of the results as discussed in the feedback session and can be used immediately with schools, work or services applications.  Within 4-6 weeks you will receive a full comprehensive report which is typically 30-40 pages long which will provide all of the details of the testing completed, conclusions & diagnoses, recommendations and resources.

Assessments are driven by the scientific data determined by (descriptive words – certified,industry-standard) tests.  The battery of tests for a client provides a collection of data which is then holistically interpreted by your psychologist who has the client's backgroundt and is experienced in this field.  As questions arise after the feedback session, we would love to answer them and provide background for any diagnoses in the report.  If you still feel uncertain as to the outcome and would like a second opinion, the final report will provide the testing data which can be provided to another expert to review.

Psychological and Neuropsychological reports typically are considered current for 3 years by State and National professional organizations.  If the client is utilizing this report for accommodations or services, please check with the providing organization as each may have its own guidelines for the frequency of assessments.

Yes, if this is desired, discuss this with the psychologist at the feedback session so the alternative report can be created at the same time as the full report with no extra charge.  Should you require an additional report after the full report has been issued and the assessment is complete please contact the front desk to discuss what specifically is needed and if

This will be discussed and agreed upon on a case by case basis before the testing begins.  Any report authorization is clearly stated in your contract, assessment policies/agreement, and/or record release form which require signature authorization. 

Some assessments have recommendations for therapy specialists depending on the diagnosis outcome.  If your psychologist may be a good fit for a recommended therapy, discuss this with them in person or via email to discuss if they are taking on any new clients at this time.