Evaluation Models

At Horizon Neuropsychological Services, LLC, we want to make our services accessible to everyone. As such, we have created three (3) models with which individuals and families can choose from to meet their needs. In order to understand the difference between these three (3) models, however, it is first important to understand the concept of “medical necessity” and how that is defined by insurance companies. According to Very Well Health:

Health insurance plans provide coverage only for health-related services that they define or determine to be medically necessary. Medicare, for example, defines medically necessary as: “Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem. Most health plans will not pay for healthcare services that they deem to be not medically necessary.

The question then becomes, “What does this mean for neuropsychological evaluations?” According to insurance companies, they will cover only what they deem to be “medically necessary” and nothing more (keep in mind that each insurance provider is different, it is suggested that the individual review their own policy for specific coverage). For example, academic achievement testing to identify or rule-out a learning disability is not considered to be medically necessary, as they considered this to be an “educational issue.” Insurance companies will also only permit reimbursement for a certain number of hours for testing, scoring, report writing, and verbal review of results. Regardless of the complexity of the case, insurance companies dictate the number of hours they feel should be spent on each case, which commonly is much less than the number of hours that neuropsychologists spend to provide adequate standards of care. As such, many neuropsychologists choose not to become paneled with insurance companies and instead require private pay. At Horizon Neuropsychological Services, LLC, however, we are making every effort to find a happy medium between providing affordable healthcare and offering the quality of services that families are looking for. As such, we offer three (3) evaluation models to choose from that best fits your needs. More details are outlined below.

For questions, please contact our office at (720) 242-7533.

Basic
Evaluation

Clinical Interview

Collateral Interview

Testing Session

Feedback Session

Abbreviated Report

Consultation

Standard
Evaluation

Clinical Interview

Collateral Interview

Testing Session

Feedback Session

Extensive Report
(with Pages of Recommendations)

Consultation

Social Work Component
(helping you find providers in your network and close to your home)

Participation in 504 Accommodation Plan and IEP School Meetings

Outlines 504 Accommodation Plan and IEP recommendations for all diagnoses
EXCEPT learning disabilities or academic giftedness in reading, writing, and math

Comprehensive
Evaluation

(learning ability evaluation to identify disabilities or giftedness)

Clinical Interview

Collateral Interview

Testing Session

Feedback Session

Extensive Report
(with Pages of Recommendations)

Consultation

Social Work Component
(helping you find providers in your network and close to your home)

Participation in 504 Accommodation Plan and IEP School Meetings

Outlines 504 Accommodation Plan and IEP recommendations for all diagnoses
INCLUDING learning disabilities or academic giftedness in reading, writing, and math

Academic Testing

Basic Evaluation

Cost (Insured): Covered by insurance. You will only be responsible for your copay, coinsurance and/or your deductible amount (if any).

Cost (Uninsured): $1900

Description: This type of evaluation is abbreviated and entirely deemed to be “medically necessary” by insurance companies. As such, it will not include many additional bonuses that are included in the Standard and Comprehensive models, which we find to be tremendously beneficial for patients.

What is included:

- - - Clinical Interview: The doctor will conduct a 30-60 minute interview with the patient regarding their symptoms, evaluation goals, and prior history (e.g., medical, developmental, adaptive, social, emotional/behavioral, academic, and occupational history).
    - Collateral Interview: The doctor will conduct a 30-60 minute interview with the patient’s parent, guardian, family member, partner, or friend (that they choose) regarding their concerns and a chronological account of how those concerns have manifested across time.
    - Testing: The doctor will conduct 4 hours of testing plus 1 hour of questionnaires (5 hours total) with the patient either virtually, in-office, or in-home (if needed). The battery will cover the following areas: IQ, verbal, visual-spatial, attention, executive functioning, memory, motor, social, and emotional/behavioral.
    - Feedback Session: The doctor will conduct a 1-hour feedback session with the patient or parent/guardian (for minors or those who have given power of attorney to another adult). The feedback session will include a review of the testing data, diagnosis, and recommendations.
    - Abbreviated Report: The report will include the referral question, background section summarizing information from the clinical and collateral interviews, list of all testing protocols, clinical behavioral observations, a brief summary of the diagnoses, top 3 recommendations, and a testing data appendix.

What is not included:

- - - The report will only include the top recommendations and is not well-suited for individuals who will want extensive reocommendations (i.e., outline of specific behavior modification steps) across settings (including the school)
    - Academic achievement testing to identify or rule-out a learning disability is not included
    - Participation in 504 Accommodation Plan or Individualized Education Program (IEP) meetings through the school district will not be included and will be charged at a rate of $250 per hour (billed in 15-minute increments)

Standard Evaluation

Cost (Insured): There is a $1,700 add-on fee that will not be billed to insurance. This fee will be in addition to what is not covered by insurance (based on your benefits).

Cost (Uninsured): $3,300

Description: This type of evaluation goes beyond what is considered to be “medically necessary” by insurance companies.

What is included:

- - - Clinical Interview: The doctor will conduct a 30-60 minute interview with the patient regarding their symptoms, evaluation goals, and prior history (e.g., medical, developmental, adaptive, social, emotional/behavioral, academic, and occupational history).
    - Collateral Interview: The doctor will conduct a 30-60 minute interview with the patient’s parent, guardian, family member, partner, or friend (that they choose) regarding their concerns and a chronological account of how those concerns have manifested across time.
    - Testing: The doctor will conduct 4 hours of testing plus 1 hour of questionnaires (5 hours total) with the patient either virtually, in-office, or in-home (if needed). The battery will cover the following areas included in the Basic Evaluation: IQ, verbal, visual-spatial, attention, executive functioning, memory, motor, social, and emotional/behavioral.
    - Feedback Session: The doctor will conduct a 1-hour feedback session with the patient or parent/guardian (for minors or those who have given power of attorney to another adult). The feedback session will include a review of the testing data, diagnosis, and recommendations.
    - Report: The report will include the Basic Evaluation sections: Referral question, background section summarizing information from the clinical and collateral interviews, list of all testing protocols, clinical behavioral observations, a brief summary of the diagnoses, top 3 recommendations, and a testing data appendix. Additionally, the report will include pages of recommendations in order of priority that will be applicable for a 2-3 year developmental trajectory (regardless of age) and the doctor will assist you in locating and contacting clinically relevant providers in your insurance network and close to your home. For those in a work or academic setting, interventions will also include accommodation plans (note: this does not include interventions for a learning disability).
    - Participation in School Meetings: Per request, the doctor will participate in the 504 Accommodation Plan or Individualized Education Program (IEP) meeting through the school district via Zoom or phone free of charge. Of note, if families wish their doctor to participate in-person, however, this will be an additional charge ($250 per hour of drive time).
    - Social Work Component: We’ll help you find providers in your network and close to your home.

What is not included:

- - - Academic achievement testing to identify or rule-out a learning disability is not included

Comprehensive Evaluation

Cost (Insured): There is a $2,200 add on fee that will not be billed to insurance. This fee will be in addition to what is not covered by insurance (based on your benefits).

Cost (Uninsured): $3,700

Description: This type of evaluation goes beyond what is considered to be “medically necessary” by insurance companies and also includes academic achievement testing to identify or rule-out a learning disability.

What is included:

- - - Clinical Interview: The doctor will conduct a 30-60 minute interview with the patient regarding their symptoms, evaluation goals, and prior history (e.g., medical, developmental, adaptive, social, emotional/behavioral, academic, and occupational history).
    - Collateral Interview: The doctor will conduct a 30-60 minute interview with the patient’s parent, guardian, family member, partner, or friend (that they choose) regarding their concerns and a chronological account of how those concerns have manifested across time.
    - Testing: The doctor will conduct 4-7 hours of testing plus 1 hour of questionnaires with the patient either virtually, in-office, or in-home (if needed). The battery will cover the following areas included in the Basic Evaluation: IQ, verbal, visual-spatial, attention, executive functioning, memory, motor, social, and emotional/behavioral. Additional testing includes academic achievement testing to identify or rule-out a learning disability.
    - Feedback Session: The doctor will conduct a 1-hour feedback session with the patient or parent/guardian (for minors or those who have given power of attorney to another adult). This will include a review of testing data, diagnosis, and recommendations.
    - Report: The report will include the Basic and Standard Evaluation sections: Referral question, background section summarizing information from the clinical and collateral interviews, list of all testing protocols, clinical behavioral observations, a brief summary of the diagnoses, extensive (pages of) recommendations, and a testing data appendix. This will also include academic testing review to identify or rule-out a learning disability. Moreover, this report will include a school section outlining all of the recommended accommodations and curriculum modifications that should be provided to the school for review.
    - Participation in School Meetings: Per request, the doctor will participate in the 504 Accommodation Plan or Individualized Education Program (IEP) meeting through the school district via Zoom or phone free of charge. Of note, if families wish their doctor to participate in-person, however, this will be an additional charge ($250 per hour of drive time).
    - Social Work Component: We’ll help you find providers in your network and close to your home.
    - Academic Achievement Testing: Testing to identify learning disabilities or giftedness.