Learn More About
Navigating insurance coverage for developmental evaluations can be confusing. Here’s everything you need to know about using insurance at Developmental on Demand.
Out-of-Network Benefits
We are out-of-network providers, which offers several advantages:
- No referral required – you can schedule directly
- No pre-authorization delays
- Faster appointment availability
- More comprehensive evaluations without insurance restrictions
- Often better reimbursement for specialized assessments
How Reimbursement Works
- Schedule your evaluation – No insurance pre-approval needed
- Pay at time of service – We accept all major payment methods
- Receive your superbill – Detailed invoice with all required codes
- Submit to your insurance – We provide guidance on submission
- Get reimbursed – Most families receive 50-80% back
Checking Your Benefits
Before your appointment, call your insurance and ask about:
- Out-of-network mental health or developmental benefits
- Deductible status (individual and family)
- Co-insurance percentage for out-of-network providers
- Whether CPT codes 96112, 96113, 96130, 96131 are covered
- Any annual limits on psychological testing
What We Provide
After your evaluation, we give you:
- Detailed superbill with all necessary CPT codes
- Diagnosis codes (ICD-10)
- Provider information and credentials
- Date of service and time spent
- Guidance on submission process
Common Insurance Questions
Q: Does insurance cover autism evaluations?
A: Most plans cover diagnostic assessments under mental health benefits. The ADOS-2 is typically well-covered.
Q: What if my claim is denied?
A: We provide documentation to support appeals. Many initial denials are overturned on appeal.
Q: Can I use HSA/FSA funds?
A: Yes! Developmental evaluations are qualified medical expenses.
Q: Do you accept Medicaid?
A: We do not currently accept Medicaid, but we offer payment plans and scholarships for qualifying families.
Maximizing Your Benefits
Tips for getting the best reimbursement:
- Schedule evaluations early in the calendar year when deductibles reset
- Submit claims promptly (within 30-60 days)
- Keep copies of all submitted documentation
- Follow up with insurance if you don’t hear back within 2-3 weeks
- Appeal denials – first appeals often succeed
Have questions about insurance? Contact us for a benefits consultation →