Will insurance cover me for the neuropsychological evaluation?

It is important to call and check with your insurance provider before you schedule an appointment for a neuropsychological evaluation. Insurers have their own criteria for whether a neuropsychological evaluation will be covered for reimbursement. Typically, it is important for the testing to be conducted for the purposes of establishing or clarifying a diagnosis and when this information cannot be adequately obtained from diagnostic screenings, treatment history, or input from family other support systems. As such, insurers may consider covering neuropsychological testing when it is deemed medically necessary and there is reason to believe that the individual suffers from neurocognitive deficits.

Some insurers will not cover neuropsychological assessments if an individual has already undergone a similar assessment in the past 12 months, or if a school-based evaluation of learning, function and/or special needs evaluation has been requested. As such, please be sure to call the number on the back of your subscriber identification card to inquire about coverage for neuropsychological assessments.

It is recommended that you have a referral (or script) from your neurologist or primary care physician before seeking treatment. If you have questions for our staff or require additional assistance, please call us at 201-577-8286.


What’s not covered by insurance?

Most insurance companies do not  cover neuropsychological testing for developmental delays, ADHD, or learning issues, as they deem these services ‘educational’ rather than ‘medical’, even if the provider is ‘in-network’.

In addition, some other types of neuropsychological testing referrals are commonly excluded under most benefit plans. Members should refer to their benefit summary plan descriptions for a complete list of exclusions. Examples of types of neuropsychological testing referrals that are usually not  a covered benefit include, but are not limited to:

a) Employer/Government mandated testing.

b) Testing to determine eligibility for disability benefits.

c) Testing for legal purposes (e.g., custody/placement evaluations, and court mandated testing).

d) Testing for vocational purposes (e.g., interest inventories, work-values inventories, and career development).
 

Dr. Burchette's specialty is in working with adults (over 18 years old) and older adults seeking assistance in determining if their cognitive difficulties are due to medically-related concerns . Dr. Burchette is a clinical neuropsychologist that practices within the healthcare domain, providing services in the context of a doctor-patient relationship to patients and their physicians or other healthcare specialists. Dr. Burchette is not a clinical neuropsychologist that specializes within the forensic area to provide forensic neuropsychological services. In addition, Dr. Burchette is not a pediatric neuropsychologist who works with children or adolescents to provide neuropsychological testing for educational or developmental delays. 

Does Dr. Burchette take my insurance?

Dr. Burchette is a contracted provider with Medicare, Cigna, Aetna, and BCBSNJ. Although he is a contracted provider for those plans you should still consult with your insurance provider to determine your coverage costs for your particular plan. The cost of a neuropsychological evaluation depends on how much time is required to do all aspects of the evaluation. Fees are based on time to complete the initial interview, review of records, total testing time, scoring/interpretation of test data, and report preparation.

For all other insurance companies, his services may still be covered in part or whole as an out-network-provider. However, you should check with your insurance plan and company to see if this may apply in your case. For insurances other than Medicare, Cigna, BCBSNJ, or Aetna, it will be requested that you pay for a portion of your evaluation out of pocket on the day of testing. Once the evaluation is fully completed, our office can provide you with a document that you can submit to your insurance company for possible reimbursement that they will send directly to you given what they deem reimbursable.