If prior authorization is required, we will complete the process and advocate for your services to be covered. In some cases—such as with TRICARE West—we know authorization is required. In other cases, like ADHD testing, requirements may vary. To be certain, we recommend confirming with your insurance provider before your visit.

Your responsibility depends on your insurance plan and whether outpatient visits to a specialist apply to your deductible. If they do, you are responsible for the full cost of visits until your deductible is met—either for the individual, for the family, or both, depending on your plan. Once your deductible is satisfied, your insurance begins covering its portion of costs. For details specific to your plan, contact your insurance provider directly.

It depends on your plan. Most require a copay for each outpatient visit with a specialist, including follow-ups. In some cases, your copay may be tied to your deductible, meaning you could be responsible for the full cost until the deductible is met. For accurate details, contact your insurance provider.

Generally, yes. Follow-up visits are usually covered in the same way as the initial visit. However, some plans limit the number of visits allowed per year, or coverage may depend on whether your plan is active on the day of the appointment. For details specific to your plan, contact your insurance provider directly. 

An ADHD evaluation at MindWeal typically includes three visits: an initial one-on-one evaluation with a board-certified provider, a 30-minute in-office ADHD test if needed, and a follow-up to review results. If we accept your insurance, these visits are generally covered, though the testing portion may sometimes fall outside of coverage. We recommend contacting your insurance provider and asking if billing codes 96132, 96138, and 96139 are covered. In rare cases, additional documentation is required, and we will provide it if needed.

Medication coverage depends on your plan. Many insurers use insurance medication lists (called formularies) with different tiers. Some medications require prior authorization, which we will complete for you. If a medication is not approved, your provider will work with you to find an alternative covered by your plan. Please note: if you have Medicaid but are using DirectPay for visits, prescriptions from our providers will not be covered. In this case, your pediatrician will need to prescribe the medication, and we will provide recommendations and coordinate directly with them.

If your coverage changes, let us know right away so we can update your records. If your new plan is accepted, we will continue billing insurance as usual. If not, you can continue with DirectPay. We can also provide a superbill (a detailed receipt with billing codes) that you may submit for out-of-network reimbursement.

Yes. Please notify us as soon as possible so we can update your information. If your new plan is one we accept, we will begin billing that insurance. If not, you can continue through DirectPay, and we can provide a superbill for possible reimbursement.

Even if we accept your insurance, you are welcome to use our DirectPay option instead. Many families choose this for its transparency and simplicity. However, if you use DirectPay when we accept your insurance, you cannot submit that payment to your insurance company for reimbursement.