Can I use my insurance?
A straight answer.
Pivot Psychological Services, PLLC is a self-pay practice — but that doesn't mean insurance can't help. Here's exactly how out-of-network benefits work, what you might get back, and how to find out before you book.
We don't bill insurance directly. What we do is provide you with a detailed superbill — a receipt with all the clinical and billing information your insurer needs — so you can submit for reimbursement yourself.
Many clients with PPO or POS insurance plans recover a significant portion of their evaluation cost. The key is knowing what to ask before you book.
Why we're self-pay — and why it works in your favor
When a practice bills insurance directly, the insurer controls the process: which tests can be run, how many hours are covered, what diagnosis must be listed, and how quickly the work must be done. The result is often a compressed evaluation designed to satisfy a billing threshold — not to answer your actual clinical question.
As a self-pay practice, Pivot has no insurance auditor looking over our shoulder. Your evaluation is built around your referral question, your clinical picture, and the depth of assessment your situation requires. You get a complete neuropsychological evaluation — not the minimum covered one.
The trade-off is that you pay upfront. But with out-of-network benefits, your effective cost is often lower than you'd expect.
How out-of-network benefits work
Most PPO and POS health plans include out-of-network (OON) mental health benefits. Here's the terminology you'll need:
| Term | What it means |
|---|---|
| OON deductible | The amount you pay out of pocket each year before OON benefits start. Once met, reimbursement begins. |
| Coinsurance | Your share after the deductible. If your plan covers 70% OON, you effectively recover 70% of the allowable rate. |
| Allowable rate | What your insurer considers reasonable for a given service. They reimburse based on this — not necessarily what you paid. |
| Superbill | A detailed receipt from your provider containing the billing codes, diagnosis, and clinical information your insurer needs to process your claim. |
| EOB | Explanation of Benefits — a statement from your insurer after your claim is processed showing what they paid and what you'll be reimbursed. |
What you might actually get back
These scenarios are illustrative. Your reimbursement depends on your specific plan and deductible status.
| Scenario | What this looks like |
|---|---|
| PPO, deductible already met, 70% OON | You pay $1,195 for a Targeted ADHD Evaluation. If the allowable rate is $1,000, insurance reimburses ~$700. Your net cost: ~$495. |
| PPO, $1,500 remaining on deductible | You pay $2,395. ~$1,500 applies to your deductible first; the remaining ~$895 is subject to coinsurance (e.g., 70% = ~$626 back). Net cost: ~$1,769. |
| PPO, deductible met, strong OON plan | You pay $3,995. At 80% coinsurance on a $3,500 allowable rate, you recover ~$2,800. Net cost: ~$1,195. |
| HMO or EPO plan | These plans typically have no OON benefits. You pay the full evaluation fee. |
| High-deductible plan, late in the year | If your deductible is mostly met, you may be in the same position as the first scenario. Timing your evaluation toward year-end can help. |
Check your benefits before you book — 5 questions to ask
Call the member services number on the back of your insurance card and ask:
| Ask this | Why it matters |
|---|---|
| "Do I have OON mental health benefits?" | Yes or No. If No, reimbursement is not available on your plan. |
| "What is my OON deductible and how much have I met this year?" | Tells you how much you'll pay before benefits kick in. |
| "What is my coinsurance for OON mental health after the deductible?" | The percentage insurance will pay once your deductible is met. |
| "Are CPT codes 96132, 96133, 96136, and 96137 covered?" | These are the neuropsychological testing codes on your superbill. Some plans exclude them. |
| "What is the allowable rate for 96132 in my area?" | Optional — gives you a realistic estimate of your reimbursement amount. |
After your evaluation — how it works
Which plan types work best
| Plan type | OON reimbursement outlook |
|---|---|
| PPO | Best option. After deductible, most PPO plans reimburse 50–80% of the allowable rate for neuropsychological evaluation. |
| POS | Usually has OON benefits, but may require a PCP referral. Confirm with your insurer before booking. |
| HMO | Typically no OON coverage. Reimbursement is unlikely. |
| EPO | Typically no OON coverage. Reimbursement is unlikely. |
| HDHP | Depends on timing. If your deductible is partially or fully met, OON benefits may be meaningful. |
Evaluation fees
All fees are flat, transparent, and posted here. No hidden charges, no surprises.
| Evaluation | Fee |
|---|---|
| Targeted ADHD Evaluation | $1,195 |
| In-Depth Neuropsychological Evaluation | $2,395 |
| Comprehensive Neuropsychological Evaluation | $3,995 |
| Comprehensive + ASD Differential | $4,995 |
HSA and FSA cards accepted. Payment is due at the time of service.
Ready to move forward?
Book a free 15-minute consultation to talk through your evaluation needs and get your questions answered — including any questions about insurance. Or go straight to booking.
