Why is psychological testing so expensive and such a long process?
An accurate psychological evaluation requires time and focus by a highly-trained and well-educated doctoral-level Psychologist. I, Dr. Steph, want to make sure you get your money’s worth by giving you more than just a diagnosis. A comprehensive testing battery looks at not only what is going on in the brain and at current symptoms, but also provides us a more objective look into your entire person. I assess patients in a more holistic way, where I want you to learn about yourself and to have ongoing treatment recommendations that include more than just traditional psychotherapy and medication.
I also do not have technicians to help me administer the tests. Administering the tests myself allows me to observe every detail within the process, as well as ensuring the test is being done properly. After one or two 3–4-hour testing appointments, it can take anywhere between 9 to 11 hours to score, interpret, and write a final comprehensive report before we are able to meet for a feedback session. Feedback sessions are held to review the results and recommendations, which is typically about 4-6 weeks later. It’s understandable to be wary about what you are paying and why it’s taking so long when you’re not witnessing what goes on behind the scenes. Ultimately, your money is going towards quality work that is executed by a doctorate level licensed Psychologist. There are also grandfathered in master’s level Licensed Practical Examiners (LPEs) whose credential is no longer attainable/recognized by the AR board of psychology as the APA is very strongly working to protect formal psychological assessment, where it can only be provided by doctoral licensed Psychologists who have the extra years of specialized training. A Master’s LPE may charge less because they likely base their rates off of health insurers’ contracted rates where most insurers pay Psychologists more per code for testing because of the higher level of education and expertise.
Why do I have such high “estimated patient costs” if I have health insurance?
Insurance is often very misleading, and even I didn’t fully understand what deductibles, co-insurance, etc. meant until I went into private practice. For example, the average American has an annual deductible of $4,364 for an individual plan, and because it is all so very nuanced, other than preventative or routine care (yearly physical, etc.), you are responsible to pay all non-preventative healthcare costs until your deductible is met. Or, maybe you’re lucky and your insurer only requires a copay for a regular outpatient visit with a mental health therapist. Your specific plan determines if your insurer will start paying full costs for all healthcare, or if coinsurance will kick in. There are often different tiers of certain plans, so not everyone will have the same benefits at the same workplace. As of late, many health insurers are refusing to even cover CPT codes I need to provide testing, which I hope to fight alongside other Psychologists because it is frustrating for both you and me. Here is a hypothetical, but very common example, of what estimated costs for ADHD testing may be:
Clinical Interview (CPT code 90791 or 96116): Your health insurance reimburses Psychologists $181.00
First hour of testing administration (CPT code 96130 or 96132): Your health insurance reimburses Psychologists $168.00
Subsequent hours of testing administration where I need to bill for 3-4 of those units with most testing cases (CPT code 96131 or 96133): Your health insurance pays 145.00 per unit, so 3 units would come to $435.00
Scoring and interpretation /report writing, first 30 min (CPT code 96136): Your health insurance reimburses Psychologists at $98.00
Subsequent 30-minute intervals of scoring and interpretation, where I need 10 units, but can only get about 3 units typically covered by insurances (CPT codes 96137 or 96138): Your health insurance pays 75.00 per unit, so 3 would come out to $225
Then, the feedback session about 4 weeks later (CPT 96130) at Your health insurance reimburses Psychologists $168.00
So, let’s go and add up all those necessary CPT codes to bill to your insurer (but as you can see, it is really not full compensation for what is involved in the entire formal testing process):
$181+ $168 + $435 + $98+ $225 + $181= $1288
Now, say you have a $4500 deductible still left at the time of the testing services, because testing is not considered routine outpatient care and is seen as a specialty service by health insurers (it would be the same seeing an allergist, an MD who went to 2 more years of grueling school, compared to your PCP who is a general practitioner, to be an allergist; I see an allergist and I have to pay each year for my shots’ serum because of my own high deductible insurance and I also just paid over $5000 for my miscarriage surgery), so you will have to pay the full estimated costs of $1288 that will be applied to your remaining deductible. And you pay this amount directly to my practice.
Often, our self-pay rates for testing are going to be much cheaper for you and then there are zero surprises from insurance claims because I have seen all kinds of things happen over the years. Your health insurer can pay/not pay a claim however they please, that is in their contract with you and with us providers. We provide courtesy estimates with your permission, something many other practices won’t do until you pay a deposit and schedule and are then locked in before knowing full costs.
PsychologyWorks, PLLC is all about transparency and this is why I write these blogs and why we offer estimated costs upfront so that you are not left in the dark with a bill you cannot afford to pay. We also offer 12-month payment plans for those who can prove financial hardship with a card stored on file and a signed agreement for monthly auto-pay. We want folks to be able to access psych testing services.
Can’t you just bill me later?
Unfortunately, this would largely affect the wellbeing of a very small private practice. Testing is expensive and people often don’t pay for the services they’re provided. This can result in clients sent to debt collections or small claims court, which ends up being disadvantageous for both the client not paying and the practice. Therefore, it is required to pay your estimated patient responsibility upfront. Half of the estimated cost is due on the day of your scheduled testing appointment and the other half is due at the time of your feedback session. If your health insurer covers more than expected, you will be reimbursed after the claim has been finalized by your insurer. It is very similar for traditional talk therapy sessions with Mary Ann or Tiffany. Even for routine mental health services, some insurance plans apply the full session rates for therapy to your deductible, so you may be paying upwards of $165 until you meet your deductible and then most plans have co-insurance, which means that you’ll pay $20-$30 for sessions until your deductible rests for the next year.
We hope this helps clear some confusion about testing and using insurance. It is difficult to find accurate information out there. Give us a call at 833-779-9675 or email us at admin@psychologyworkspllc.com if you have any questions about testing or want to get on the schedule!