Rates and Insurance

Dr. Carbone's service model is predominantly private pay at the time of service.  This allows her to:

• Spend more time with her clients;
• Collaboratively make treatment decisions with her clients rather than receive directives from insurance companies or managed care organizations; and 
• Utilize academic and learning interventions that are not covered by health care plans.

BCBS of Illinois

In 2017, Dr. Carbone remains in network with BCBS of Illinois PPO only. Dr. Carbone is not in network with any other insurance panels.  Many times insurance plans will reimburse clients and Dr. Carbone will provide the necessary documentation for clients to seek reimbursement.

If clients would like to use BCBS, please be aware that each plan is unique and many times, BCBS plans may not cover particular services (i.e., neuropsychological testing) or will only cover services for particular diagnoses. Dr. Carbone encourages all clients to call and discuss their plan benefits in detail with their insurance provider. Please keep the following issues in mind when considering using BCBS for neuropsychological evaluation services:

• Dr. Carbone will accept the BCBS PPO contracted rate for medically indicated neuropsychological evaluation services (CPT code 96118).  This is consistent with BCBS guidelines. Medically indicated services often involve referral by a physician who is interested in uncovering factors that are related to medical (i.e., traumatic brain injury, epilepsy, diabetes) issues in order to address medical treatment needs.
• BCBS policies indicate that they do not provide coverage for neuropsychological testing for the determination of ADHD. Additionally, BCBS does not provide coverage for neuropsychological testing for educationally-based evaluations that address learning disabilities unless they are related to a medical or neurological condition. 
• BCBS may only cover a limited number of hours of testing (i.e., 8 hours in total) and many times, comprehensive evaluations can require up to 14 hours of the neuropsychologists time to administer, score, interpret, and write reports for the evaluation.
• BCBS does not cover phone consultations with teachers or other allied professionals, which may be necessary for a comprehensive evaluation. 

Educationally-based evaluations and interventions are designed to address educational concerns including:

• Determining the presence of a reading, math, or written language disability;
• Assisting with decisions regarding school placement;
• Determining whether a child or adult is eligible for academic plans (i.e., IEP or 504 Plan) or standardized testing accommodations

Educational evaluations are not classified as medically indicated services and are not covered under most BCBS PPO plans. Clients are encouraged to check with BCBS to verify this information. Please feel free to call and speak with Dr. Carbone about referral questions and BCBS insurance allowances and limitations.

Neuropsychological Evaluation services

The cost of a comprehensive evaluation ranges from  $3,600.00 - $4,200.00. Neuropsychological evaluations typically involve: 2 hours of interview, 6-8 hours of testing, 2 hours of scoring and analysis, 4 hours of report writing, and 1-2 hours of feedback with clients and/or their families. On average, the neuropsychological evaluation requires approximately 16 hours of time (i.e., including formal testing, analysis, consultation, report writing, and feedback). 

**Evaluations that are requested for academic purposes or decision-making (i.e., referred by school, requests for updated evaluations for accommodations, or are designed for evaluation of a learning disability) are not covered by BCBS or most insurance plans. 

Intervention Services

The rate for individual intervention services is $225.00 per 55-60 minute session. Intervention services are tailored to each client's unique neuropsychological profile and learning needs. 

**Intervention services that are requested for academic purposes (i.e., learning skill strategies, school consultation) are not covered by BCBS or most insurance plans.