Insurance

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We are in-network provider for a number of insurance plans  (please see the list below). Services for Neuropsychological or Cognitive evaluation/testing are covered under your medical benefits.  Services for psychotherapy or counseling are covered under your Behavioral or Mental Health benefits.  

Educational or school testing is typically NOT covered by any health plan, as these services are not seen by health insurance as being “medically necessary” and thus need to be self-pay (Please contact  us at 949-481-8414 ext 3 for the cost. We accept cash, check, MC/Visa)

We urge you to contact your insurance company to confirm benefits, prior to your first appointment, as we are not responsible for confirming your benefits.  Please scroll down to the end for a list of specific questions to ask your insurance plan regarding eligibility and benefits.

Dr. Kalinian is in-network provider in the following plans:

AETNA

ANTHEM BLUE CROSS

GREATER NEWPORT PHYSICIANS (GNP) (ALL HMOs FOR NEUROPSYCHOLOGICAL TESTING REQUIRE PRE AUTHORIZATION  FROM THE MEDICAL GROUP)

MEDICARE

MEMORIAL CARE MEDICAL GROUP  (ALL HMOs FOR NEUROPSYCHOLOGICAL TESTING REQUIRE PRE AUTHORIZATION  FROM THE MEDICAL GROUP))

MISSION HERITAGE ST. JOSEPH HEALTH SYSTEMS (ALL HMOs FOR NEUROPSYCHOLOGICAL TESTING REQUIRE PRE AUTHORIZATION  FROM THE MEDICAL GROUP))

MISSION HOSPITAL AFFILIATED PHYSICIANS (MHAP) (ALL HMOs FOR NEUROPSYCHOLOGICAL TESTING REQUIRE PRE AUTHORIZATION  FROM THE MEDICAL GROUP))

OSCAR (ALL HMOs, REQUIRE PRE AUTHORIZATION)

UNITED HEALTH CARE/UNITED BEHAVIORAL HEALTH (UBH/UHC)

Dr. Daniel is in-network provider in the following plans

AETNA

ANTHEM BLUE CROSS

CIGNA

MEDICARE

MEMORIAL CARE MEDICAL GROUP  (ALL HMOs FOR NEUROPSYCHOLOGICAL TESTING REQUIRE PRE AUTHORIZATION  FROM THE MEDICAL GROUP))

OPTUM

UNITED HEALTH CARE/UNITED BEHAVIORAL HEALTH (UBH/UHC)

Please ask your insurance the following questions for coverage with Dr. Haygoush Kalinian or Dr. Colleen Daniel:

For Neuropsychological Testing: When calling your insurance plan, say “My child (or )I am going to see a specialist for a medical diagnosis, the specialist will use these procedure (CPT) codes (99245, 96116, 96118, 96120)” Ask the questions below

For Psychological Testing (Beriatric, Pre-Surgical, or Mental Illness)  When calling your insurance plan, say “My child (or )I am going to see Dr. Colleen Daniel who will use these procedure (CPT) codes (90791, 96101, 96103)” Ask the questions below:

For Counseling or Psychotherapy: When calling your insurance for Mental Health benefits, say “My child (or )I will be seeing Dr. Colleen Daniel for counseling or psychotherapy and she will use these CPT codes (90791, 90834, 90837) & ask the questions below:

1. What is my remaining annual deductible?

2. What is my co-pay to see a specialist?

3. What is my co-insurance for each CPT listed above? (this is typically a percentage)?

4. Do I need precertification or pre-authorization for the CPTs listed above?  If you have a PPO/POS plan, you typically will not need a preauthorization, but ask just to confirm.

Please note:  All out of pocket costs (co-pay, deductible etc) are due during your 1st appointment.  We accept cash, check, & credit card (MC/Visa)

•For billing questions:

If you have any questions/concerns about your bill, please call Erin  at Precise Practice Management 1-845-728-0666

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