Insurance Worksheet for Psychological Testing

Insurance Worksheet for Psychological Testing

2611 Washington St, Pella, IA 50219 l Phone: 641-628-9599 l Fax: 641-621-1493
Psychological testing is often covered by your health insurance policy. However, given that you are ultimately responsible for the cost, and payment will be expected at the time of service, it is also helpful for you to check your own insurance benefits. The following is a worksheet meant to guide you in asking for the appropriate information.

To begin, have your insurance information available and call the customer service number on the back of the card. When you call, you will be requesting benefit information. Our services are billed as an office visit under a PCP, and our providers are in network with your insurance.
Questions to ask when calling your insurance company:
1) Is psychological testing covered by my insurance?
2) Does my insurance cover the following CPT Codes (procedural codes)?
90791
96136
96137
96130
96131
3) Do I have a deductible? If so how much is left?
If yes, will my testing cost go toward my deductible?
***they may ask how this appointment will be billed; testing is billed as an office visit under a PCP
4) Do I have a co-pay? If so, how much is my co-pay?
***Please note that testing usually results in two co-payments
5) If I DO NOT have a co-pay, do I have co-insurance?
***Co-insurance means you will pay a percentage of the allowed rates; that amount will vary
Calculated Total
(To calculate your total, add your deductible and your co-pay or co-insurance amount)
Name of Testing Patient*

First NameLast Name
After you have spoken to your insurance company, if you have additional questions, please feel free to contact our office at 641-628-9599.
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Insurance Worksheet for Psychological Testing

Questions to ask when calling your insurance company: