Billing and payment
What does screening cost, and does my insurance cover it?
Full payment is due upon completion of screening. The cost you are responsible for will be reflected on your monthly billing statement, or you can view your account balance by logging in to the patient portal shortly after screening is completed. We encourage patients to reach out to our billing staff, Alana Gillespie (agillespie@rcbm.net) and James Fields (jfields@rcbm.net), to arrange a payment plan, if desired or necessary.
Insurance coverage of diagnostic screening (procedure codes 96138 and 96139) varies by plan. If it is covered, please note that you will be responsible for your deductible and one co-pay/coinsurance per screening unit (half hour). If it is not covered, you will be responsible for payment in accordance with RCBM’s Private Pay fee schedule.
Ultimate payment responsibility rests with the patient.
Is Diagnostic Screening billable to my insurance?
Diagnostic Screening at RCBM is a billable service to certain BCBS-PPO, BCBS-Federal, Aetna, Cigna, and Medicare Plus Blue plans only*.
· *Please be aware of mental health care outs: Some insurance policies have a “carve out” where mental health benefits are provided through a contract with a separate provider or insurance company. For example, some BCBS medical insurance plans have a carve-out that requires all mental health claims to be submitted and processed by Beacon Health Options. Our screening is NOT billable to Beacon Health Options, and therefore, patients with this carve-out plan will be responsible for the Private Pay fee for Diagnostic Screening.
· *BCBS PPO through Ascension typically does NOT cover the diagnostic screening provided by RCBM. The Billing Department will bill Ascension BSBS for the diagnostic screening. Please note that if the claim is denied, you will be responsible for the out-of-pocket screening costs.
· *Note that ONLY Medicare through BCBS – the Medicare Plus Blue plan – is billable for screening. Screening cannot be billed to any other Medicare plans.
This information is NOT a guarantee of benefits or payment. If your insurance company is billed and you have not met your deductible, you can expect to pay between $150.00 and $400.00, depending on the services performed and the patient’s age.
Private Pay Rates: If your insurance carrier is not listed above, RCBM is *not able to bill* your diagnostic screening to your insurance, and you will be responsible for the Comprehensive Diagnostic Screening Private Pay rate of $350.00 for individuals ages 8+; $250.00 for individuals ages 4-7.
The contract states Diagnostic Screening is not billable to my insurance, but I called my insurance company, and they said that it is billable. So is it billable?
RCBM’s Diagnostic Screenings are conducted by trained psychometricians under the supervision of Joel L. Young, MD, Medical Director. RCBM’s psychometricians are responsible for scoring the data and compiling it into the patient’s diagnostic screening report. Some insurance companies only cover screening or assessment services completed by a licensed mental health clinician (e.g., LP, LLP, LMSW, LPC, etc.) and do not cover assessments completed by psychometricians.
If our website states that we are unable to bill your insurance, your insurance does not cover diagnostic screening completed by trained and supervised psychometricians.
If the 96138 and 96139 codes are a covered benefit on your insurance plan, but are not billable to your insurance by RCBM (because we are not “in-network” for screening/evaluation services specifically), you have the option of finding an in-network provider to perform the screening. *If you proceed with the Screening at RCBM, you are responsible for out-of-pocket payment of this service.*
*Note. All diagnostic interpretations are made by one of RCBM’s licensed clinicians.
Diagnostic Screening was once billable to my insurance but according to the contract, now it is not billable. Is this correct?
Diagnostic Screening billing codes and contracts may change. If our contract indicates that this code is not billable to your insurance, this is the most current information we have.
What if I cannot pay for screening and do not want to proceed due to the cost of Diagnostic Screening?
(agillespie@rcbm.net) and James Fields (jfields@rcbm.net) to discuss payment plan options.
If you have contacted our billing department and do not want to proceed with screening, please contact your clinician regarding how this may impact your care and treatment planning. Please notify your assigned psychometrician via email so they may update your chart.
