Blue Care Network (BCN) Neuropsychological Testing Coverage Information For Subscribers and Providers

Psychological and neuropsychological testing are important tools for diagnosing, treating and managing mental health conditions. The type of testing is often covered by health insurance policies like Blue Care Network (BCN). However, understanding whether your policy covers these tests, what the criteria are for coverage, which providers offer them, and other related questions can be confusing. This article will provide an overview of BCN’s coverage for psychological testing services, as well as answer frequently asked questions about the subject. It will also discuss what to do if BCN does not cover your procedure. 

BCN Neuropsychological Testing Coverage Guide

BCN Psychological Testing FAQ Table of Contents

Does Blue Care Network HMO Cover Psychological Testing?

One of the most common questions about Blue Care Network and their HMO plans, is whether it covers psychological testing. The answer is yes, BCN will cover certain types of psychological and neuropsychological tests as long as they meet their criteria for medical necessity. However, the exact tests covered may vary depending on your plan and the provider you choose to use. It is important to understand the specifics of your BCN policy before scheduling an appointment for psychological testing. Although BCN will never guarantee coverage or payment to a provider, it is also advisable to contact the provider prior to service in order to determine which tests are covered and possible out-of-pocket costs you may incur.

How To Find a Blue Care Network Provider For Psychological and Neuropsychological Testing

When searching for a BCN provider that specializes in psychological and neuropsychological testing services, the best place to start is by looking at the list of providers available through Blue Care Network. The list includes both in-network and out-of-network providers as well as their specialty areas and contact information. It is important to note that not all providers will accept BCN insurance, so it is important to call and verify coverage before scheduling an appointment. Additionally, you can also search for a provider through the BCN website or by using their online provider directory tool.

Does Blue Care Network Have Strict Criteria For Medical Necessity?

Blue Care Network’s criteria for medical necessity when it comes to psychological testing services is based on whether the tests are necessary to diagnose, treat or manage a mental health condition. In order to be approved for coverage, the tests must be deemed medically necessary by your healthcare provider and documented in their medical record. Additionally, BCN may require a prior authorization from your doctor before they will approve payment for services.

Do I Need a Prior Authorization For Psychological Testing Services With A Blue Care Network Policy?

In some cases, prior authorization is required for psychological testing services with a Blue Care Network insurance policy. This means that your doctor must submit the necessary paperwork to BCN in order to prove that the tests are medically necessary and should be covered by your plan. If BCN does not approve the request, you may be responsible for out-of-pocket costs or have to pay a higher deductible. Additionally, some providers may not accept BCN insurance if they do not receive prior authorization from the company. 

What CPT Service Codes Do Providers Use For Psychological and Neuropsychological Testing?

When it comes to understanding what service codes are used for psychological and neuropsychological testing services with Blue Care Network, you should contact the provider prior to scheduling an appointment. The provider will be able to tell you which codes they use and if they are covered by BCN insurance. Additionally, it is important to know that some providers may have their own codes for services that are not recognized by BCN. In these cases, you may need to submit a claim with the provider’s code in order to receive reimbursement.

We offer psychological assessments that are divided into three appointments. The codes for these appointments are as follows:

Intake: CPT 90791
Testing, Scoring, Interpretation, and Write-Up: a combination of CPT codes 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139
Feedback: 90837

The total cost for the entire service is generally in the range of $2300-$2700 or more, including any deductible that you may need to pay. However, please note that reimbursement rates may change from year to year and can vary depending on your insurance plan. As a result, the final cost of the assessment can only be determined after the claim has been processed by the insurance company

What Happens In The Event That Blue Care Network Denies My Claim For Psychological Testing Services?

If Blue Care Network does not cover your psychological testing, you have a few options. You can contact the provider’s office to discuss billing and payment options, you can consider purchasing a supplemental insurance policy that may provide coverage for the tests, or you can seek out other providers who may accept your insurance plan. Additionally, some mental health professionals offer a sliding scale fee or discounted services for those without insurance. You can also look into patient assistance programs, which may provide financial help for those in need of psychological testing services. It is important to keep all of these options in mind if Blue Care Network does not provide coverage.

You should also take note that, even if you are denied coverage by your insurance plan, you can still appeal the decision. Be sure to have all the necessary documentation ready in order to support your case. It is also recommended that you contact a lawyer if you feel that Blue Care Network has acted unfairly or discriminately while denying coverage for psychological testing. You may be able to secure coverage by appealing the initial decision. With the help of an experienced attorney, you can present your case and get the coverage that you need for psychological testing services.

These are just some of the steps that you can take if Blue Care Network does not cover your psychological testing. Be sure to explore all options available to you in order to secure the care that you need. With proper research and preparation, you can find a way to get the testing that you require.

BCN Psychological Testing Coverage Takeaways

In conclusion, Blue Care Network insurance plans may cover some or all of the costs related to psychological and neuropsychological testing. However, it is important to understand their criteria for medical necessity and prior authorization requirements before seeking services. It is also recommended that you research providers in your network who specialize in this area, as well as familiarize yourself with the CPT codes used for these services. If Blue Care Network does not cover your psychological testing, it may be possible to seek other forms of coverage or payment options that could help with associated costs. Ultimately, speaking with a mental health professional can provide further guidance and insight into which course of action would best suit your individual needs.

Front desk staff may not always have the appropriate clinical expertise to answer questions about your unique situation. That’s why we provide quick and efficient consultations with experienced clinicians.