Costs and Medicare

Our Costs
We charge $250-$300 per hour for the time spent: preparing/reviewing medical records; face-to-face testing, providing feedback to family; test scoring and interpretation; and for writing report and letters to recipients. We do not charge for travel time or costs, unless we are going to Martha’s Vineyard, Nantucket or more than 30 minutes away. We do charge a $400 No Show fee if you miss your appointment, unless we have 24 hours or more warning that you need to cancel. No Shows includes forgetting, medical emergencies, car breakdowns, etc. The time is reserved for you and if we don’t have time (that 24 hours) to re-fill the appointment we need to cover our basic costs.

If you have Medicare
Most of our patients are over 65 and have Medicare. If you have Medicare Part B (which is the part that pays for doctors) or Railroad Medicare and your primary care provider (PCP) refers you, we can bill your evaluation to directly to Medicare as long as a diagnosis is yielded. If we discover you really want a "non-medical" evaluation (e.g., to find out if someone competent to sign legal papers) then we can't bill Medicare for that. We'll warn you about this, as we do our initial interview taking your "problem statement."

Another problem arises if you don’t have a cognitive deficit (that's the good news!). Maybe you were worried because there was dementia in your family. The problem is that without a diagnosis Medicare won't pay–remember we have a disease-care system, not a health-care system. In the US you really have a disease care provider, not a health care provider as Medicare only recently started paying for a Preventive visit & Yearly Wellness Exam. For the curious, here's guide to Medicare's Preventive Services. They cover screening for tobacco use, obesity screening and counseling, prostate cancer screening and so on–but not dementia screening. So we need to derive a diagnosis from your neuropsychological evaluation in order for Medicare to cover its cost.

Most often we can find a non-cognitive diagnosis like depression or anxiety playing a role in a patient's concerns. For example, we can use a diagnosis of Adjustment Disorder with depressed mood or with anxiety– this is useful if a patient is so worried about potentially having dementia that it has caused them much stress to the point where you were losing sleep, couldn't concentrate at work or felt uncomfortable in social settings (e.g., fearful of making mistakes in public). By definition an Adjustment disorder disappears in six months, so this diagnosis won't hang in your medical records forever. If you, or your doctor, feels you meet the following criteria, we can probably use this diagnosis in order for Medicare to pay for your evaluation:

Adjustment disorder is an abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected and can result in significant impairment in social, occupational, or academic functioning.

Talk to your doctor who can screen you to make sure there is a "real" problem, at least meeting the criteria above, before you ask to see us. We can only bill Medicare by using a mental health diagnosis of some type.

In cases where we can bill Medicare, Medicare pays us 80% of their “allowed” rate which is far less than our normal fee. In fact, the Medicare rate for psychotherapy is less than Medicaid, which serves the indigent and poor! We know of no private psychiatrists accepting new Medicare patients in southern Massachusetts. The remaining 20% copay is around $120. Remember, there is also a $100 deductible which you must pay, out-of-pocket, against the first few doctors visits of each new year.

Medigap or Supplemental Insurance
Medicare supplements (i.e., "Medigap") insurances often–but not always–pay the 20% gap and $100 deductible. Most BC/BS Medex, Federal BC/BS, Bankers Trust, TriCare plans will pay both the gap and deductible, while AARP pays the 20% gap but not the deductible. Some companies like Aetna, Prudential, Wassau and Cigna offer minimal benefits or may have ridiculously high deductibles (e.g., $2500/year) and thus pay little or nothing, but they will credit the costs (what you pay) against your deductible for the year. HMO-based supplements (Harvard Pilgrim and Tufts First Seniority) often do not pay any amount due. They want you to see doctors in their “network” but when you call to find a neuropsychologist they will refer you to a social worker. Yes, they know better but it is what it is. They even have grades of insurance, like HP "enhanced" gap insurance will pay the copays, but not their standard plan. Call and ask them, if you are worried about the copay amounts.

Dr. Elovitz has applied 5+ times to join Tufts with no response. Finally the Tufts preferred group of physicians on the Cape demanded they respond, and Tufts said they would consider his application after he wrote a letter telling them why he wanted to join–Duh! Well, since Tufts pays about the lowest rates of all private insurances and Dr. Elovitz was plenty busy, he could not think of a reason he wanted to join, or deal with their hassle, so he did not write them a letter and he is still not in their plan. Don't count on their promise to pay him out-of-network, they haven't in the past so he won't accept the promise to do so. In these cases you pay us and then you seek reimbursement, as your insurer is far more likely to pay you (than a provider) to keep you as a client. Remember you can change your Medigap insurer at re-enrollment periods during the year.

But wait, it can get even worse! Other companies like United HealthCare/United Behavioral Care (and GIC which, unfortunately, contracts with UHC/UBC) simply ignore our bills, they often do not issue denials and leave us all in limbo. We accept the newer Medicare “Advantage” plans, which typically leave you responsible for only a small co-pay of around $20; see the next page for more information. However, we are not obligated to take any Advantage plan since they are not standard ("traditional") Medicare, to whom we are contracted and must accept. We reserve the right to refuse to bill some of these companies (mostly UBH) on your behalf, if we've had nightmare experiences with them in the past. We'll ask you to pay us, and then you can "try" to seek reimbursement on your own. Remember, you can change your insurance back to traditional Medicare during the yearly re-enrollment period.

You can read tons about medical insurance (if you're desperate for entertainment) later in this website.

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