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Payment & Insurance Options​​

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Ocean State Assessment accepts both insurance and direct pay (self-pay) for evaluation services. This flexible approach allows individuals and families to choose the option that best fits their clinical needs, timing, and financial circumstances.

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Planning to use insurance? The practice currently accepts:

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  • Blue Cross & Blue Shield 

  • UnitedHealthcare / Optum

  • Neighborhood Health Plan of Rhode Island (NHPRI)

  • Aetna

  • Harvard Pilgrim

 

Important Note: Insurance coverage varies between each insurance company and between specific plans provided by each insurance company.  I will do my best to help you understand deductibles, copays, and coverage specifics. Everyone planning to use insurance to cover evaluation services is encouraged to contact their insurance company to confirm directly with them. 

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Self-Pay (Direct-Pay) Option

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Ocean State Assessment offers evaluations on a self-pay (direct-pay) basis. For self-pay services, Ocean State Assessment offers clear, predictable costs to you. No hidden fees, deductibles, or authorization denials.   

 

In addition, self (direct) pay will allow us to move forward with evaluations quickly, without the typical delays involved in using insurances. For most self-pay evaluations, Ocean State Assessment can get you through the evaluation process—from initial contact through receipt of the written report— within a matter of weeks. (Insurance processing and administrative demands often draw this process out, resulting in slightly longer turn-around times). 

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Can I be Reimbursed by My Insurance if I Choose Direct Pay?

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Reimbursement by your insurance company is possible. Some insurance plans may reimburse a portion of evaluation services provided on a self-pay basis, depending on individual out-of-network benefits. Upon request, Ocean State Assessment can provide you with a detailed superbill that you can submit to your insurance carrier when requesting reimbursement from them.​ These specific reimbursement decisions are made by the insurance provider and are not guaranteed.

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Do You Accept Employee Assistance Programs (EAPs)?

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Ocean State Assessment can work with Employee Assistance Programs (EAPs) when evaluation services are eligible under an individual’s plan. Coverage, authorization requirements, and allowable services vary by employer and by each EAP provider.

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If you're considering the option of using an EAP to cover evaluation services, you are encouraged to contact your EAP directly to confirm available benefits and to discuss whether evaluation services may be covered or if they require prior authorization.

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Additional Questions & Planning

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Everyone is welcome to contact me directly at Ocean State Assessment with questions about payment, payment options, and insurance coverage. I will do my best to provide as much information and guidance as possible.  

 

That being said, because insurance coverage and reimbursement vary widely, individuals and families are encouraged to contact the practice directly to discuss payment options, anticipated timelines, and whether using insurance or self-pay is the best fit for their situation.

What are options for direct pay?

What Forms of Payment are Accepted?

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Ocean State Assessment accepts most forms of payment, including cash, credit card, debit card, and check (payable to Ocean State Assessment, LLC). Payments may be made in person or securely online through the patient portal. Most major credit cards are accepted.

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Do you Have Payment Plans?

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Ocean State Assessment understands that comprehensive evaluations can be a significant financial investment. In some cases, payment plans may be available when the cost of an evaluation would otherwise cause undue financial strain.

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Payment plans are arranged in advance and typically involve:

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  • A required initial payment at scheduling

  • One or more scheduled payments during the evaluation process

  • Final - Full payment to conclude the agreed upon plan

 

Payment plans are offered on a case-by-case basis.

 

Is There a Sliding Scale for Direct Pay?

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In extenuating circumstances, Ocean State Assessment may offer sliding scale options for evaluation payment. â€‹Availability is limited and requirements for consideration will be discussed when requested, and these options are considered individually based on need, scope of services, and current capacity.

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Non-Payment Policy

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Ocean State Assessment is committed to working collaboratively with individuals and families to address financial concerns. If payment issues arise, we encourage prompt communication so that options can be discussed.

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In the absence of communication or payment arrangements, outstanding balances that remain unresolved may be referred to a collections agency, though only as a last resort.

​What Evaluations are Not Covered by Insurance?

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Insurance plans do not typically cover the following services, as they are generally not considered by insurance carriers as medically necessary:

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  • Educational evaluations

  • Gifted evaluations

  • Additional consultation or meeting time beyond what is included in the evaluation process

  • Court appearances or testimony related to forensic evaluations

 

These services are offered on a self-pay basis.

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Good Faith Estimate (GFE) & the No Surprises Act

 

Under the No Surprises Act, individuals who are uninsured or who choose not to use insurance have the right to receive a Good Faith Estimate (GFE) of the expected cost of services.

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A Good Faith Estimate provides an overview of anticipated fees for evaluation services and helps you understand potential costs before services begin. This estimate is based on the information available at the time and may change if the scope of services changes or if additional services are requested or recommended.

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You have the right to dispute charges if the total billed amount substantially exceeds the Good Faith Estimate, as outlined by federal law. Additional information about your rights under the No Surprises Act is available at www.cms.gov/nosurprises or by calling 1-800-985-3059.

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Ocean State Assessment is committed to transparency and will review all fees, estimates, and financial responsibilities with you prior to beginning services.

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