Child New Patient Questionnaire

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Insurance Billing

In order to provide you with the highest quality of service, Gray Matters is not affiliated with insurance companies. This decision is based on our commitment to provide the best treatment possible, free of managed care and insurance restrictions. We apologize for any inconvenience this may cause. We are pleased to report that many of our patients are able obtain reimbursement for portions of our services through their insurance plan’s out-of-network benefits.

We will provide itemized receipts that may be submitted to your insurance carrier. It is your responsibility to determine any possible insurance coverage. Patients (or the responsible parties) are responsible for all charges, whether covered by insurance or not. Payment is due when services are rendered. For your convenience, we accept all major credit cards.

It is a good idea to contact your insurance carrier before your appointment. They may not pay for qEEG Brain Mapping or Neurofeedback. They also may not cover services provided by a psychologist outside of their network, and/or may require prior authorization of sessions.

Here are some questions to ask:

  1. Is there coverage in my policy for biofeedback, or behavioral health services? (Biofeedback is the broad category under which qEEG brain mapping and Neurofeedback are usually recognized, and more likely to be approved.)
  2. Is prior authorization required for reimbursement to be made?
  3. If prior authorization is required, what are the procedures to obtain the initial authorization? (They may have specific forms.)
  4. What information is required to authorize sessions?
  5. How many sessions are initially authorized for reimbursement?
  6. What are the procedures for authorizing continuing treatment beyond the initial number of sessions authorized?
  7. Does my policy reimburse the full amount of the provider’s fee for services?
  8. Is there a co-payment for services; if so what is the amount?
  9. Is there an annual deductible that must be met before the insurance carrier will reimburse for services?
  10. Does use of my insurance policy allow the insurance company to review records regarding my treatment? If so, who would have authorization to review my records?
  11. Will information about my health history be provided to other parties, including other insurance companies?
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