Insurance and fees
We verify your benefits and confirm your expected out-of-pocket cost in writing before anything goes on the calendar. No one should learn what an evaluation costs from a bill six weeks later.
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Insurance
Coverage varies by individual policy, even within the same carrier. Tell us your plan on the form and we verify your benefits and confirm your expected cost in writing before anything is scheduled.
We are adding other payors. If your plan is not listed, please ask. Coverage still depends on your individual policy, so we confirm your benefits directly either way.
Two routes are often available. We can request a single case agreement so your plan covers us as an exception, or we can help you use your out-of-network benefits. Both are explained below, and we walk you through them on the intake call.
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Other situations
When a plan has no in-network provider who can evaluate your child in a reasonable time, it will often authorize us as an exception for that one case. We make the request on your behalf. It takes 2 to 4 weeks and there is no charge to try.
Many PPO plans reimburse a share of an out-of-network evaluation. We provide an itemized superbill with the diagnosis and procedure codes your plan needs, and you submit it for reimbursement.
A published flat rate of $1,850 covers the full evaluation, the feedback session, and the written report. You receive a Good Faith Estimate in writing before scheduling, as federal law requires.
We are not currently contracted with MO HealthNet managed care organizations and cannot bill them for evaluations. If your child is covered by a MO HealthNet plan, please reach out anyway. We will point you to providers who can help, including your regional DMH Regional Office and, for children under three, Missouri First Steps.
Be your own advocate
We handle this verification for you. If you would like to check for yourself first, and some families do, call the member services number on your card and ask these questions. Write down the date, the representative’s name, and the reference number for the call.
If you are uninsured or paying out of pocket, federal law entitles you to a Good Faith Estimate of what your care will cost. We provide one in writing before scheduling, without being asked.
Billing questions
No. The 30-minute intake call is free and is not billed to your insurance. It exists so that no one pays for an evaluation that turns out to be the wrong step.
The evaluation is billed the same way either way. Insurers cover the assessment itself, not the result. A ruled-out diagnosis is a legitimate clinical finding, and you still receive the full report.
Yes. Payment plans are available. Ask on the intake call and we will set one up that works for your family before anything is scheduled.
Because we are getting a real answer rather than a guess. That means reaching a person at your plan, confirming the specific codes, and documenting what they said. It is the step that prevents surprise bills later.
No. Releases to providers, schools, and agencies you authorize are included.
Tell us your plan on the form and we come back with real numbers, not a range.
