Patient Financial Responsibility and Financial Policies for Bariatric Pre-Surgical Psychological Evaluations

Bariatric psychological evaluations are typically covered by most major insurance carriers under a patient’s medical and mental health benefits.  If I am not in network with your insurance plan, I will charge a discounted rate for Bailey Center for Bariatric Patients, ranging from $450-$500 for the evaluation (which is comparable to what insurance policies typically reimburse for psychological evaluations), if you do not have out-of-network benefits. 

If I am in your insurance network, your financial obligation may range from $0 to $600, depending on several factors.  Most patients’ insurance contracts require patients to pay a copayment ranging from $20 to $50.  Many insurance plans also require patients to pay a co-insurance of 20% of the evaluation charges.  All estimated copayments and co-insurance are due at the time of service of your evaluation, as stipulated in patients’ insurance contracts.  Additional fees that remain after your insurance company reimburses your provider are due upon receipt of your invoice from me/my billing agency.  These are requirements of patients’ insurance contracts, and I cannot “waive” these payments, which violates terms of both patient-insurance contracts and provider-insurance contracts. 

Also, many patients’ insurance plans have deductibles.  A deductible is a certain amount of money that patients must pay health care providers before their insurance plan reimburses providers.  Deductibles range from $350 to as high as $5000.  As stipulated in patients’ insurance plans, deductibles owed are due at the time of service.  Often, patients mistakenly believe that because they have insurance, all charges for the evaluation will be covered.  Also, coverage for surgery is different from what is covered and not covered regarding your psychological evaluation.  The actual out-of-pocket patient cost varies tremendously by each insurance plan.  For patients who have met their deductible, or who do not have a deductible, the average out-of-pocket costs for the psychological evaluation range from $20 to $150, including copayments and co-insurances, unless a patient has an umet deductible. 

I will make every effort to verify your insurance benefits prior to your evaluation.  However, please remember that it is your responsibility to know and understand the terms of your insurance policy (e.g., your deductible amounts, copayments, and co-insurance percentages).  Please call the customer service number on the back of your insurance company to ask about your benefits if you are unsure about your insurance coverage.  Also, having insurance is no guarantee of coverage, and this is always stated to patients when insurance companies provide information on benefits and eligibility.  You, and not your insurance company, are responsible for payment for your psychological evaluation.

You will receive a call from my insurance consultant with a breakdown of estimated deductible owed, copayments, and co-insurance prior to your appointment.  All deductibles, copayments, and co-insurances are due at the time of service of your evaluation.  In cases of significant financial hardship, I can accept 2 payments, with the first installment due at time of service and the second payment the following month.  As a program requirement, all fees owed for your psychological evaluation must be paid to your provider prior to your surgery.

Thank you for your cooperation with the financial policies regarding your psychological evaluation.

Dr. Riley