How to Clarify your Insurance Benefits

1. (Optional) Print or open one of the templates below to take notes about your benefits:

   Google Docs (this link will prompt you to make a copy of the template that you can then edit)

   Microsoft Word (this link will download an editable Word version of the template)

   PDF (this link will open a printable PDF version of the template)

2. Call Member Services (check the back of your insurance card for a phone number)

3. Ask whether any deductible, coinsurance, and/or copayment applies to psychological testing services.

   • You will likely be asked for procedure (CPT) codes for the evaluation. The CPT codes are as follows:

     • 90791

     • 96130

     • 96131

     • 96136

     • 96137

   • You may also be asked to provide an ICD-10 diagnosis code. A tentative code to provide is F43.20.

4. The member services representative will describe your benefits. Take note of whether each CPT code is subject to a deductible, coinsurance, and/or copayment.

   • Deductible: The amount you pay for healthcare services before your health insurances begins to cover

   • Coinsurance: Your share of costs for healthcare services, represented as a percentage

   • Copayment: A fixed fee for healthcare services that varies by service

5. If a deductible or coinsurance applies, reference the Insurance Adjusted Estimate to determine your approximate out-of-pocket costs.

   • Please note that the document above is provided as a Good Faith Estimate based on the typical number of hours billed for most evaluations and the average insurance-adjusted rates. The exact amount you owe may differ from the estimate.