Lisa LoPinto, Clinical Psychologist, P.C. *
Developing Positive Behavior In Children And Adolescents
FREQUENTLY ASKED QUESTIONS
Do you accept insurance?
How do I find out if I have Out-of-Network (OON) coverage, how much my deductible is, and how much I will be reimbursed?
Why doesn't Dr. LoPinto participate in my insurance plan?
How will Dr. LoPinto determine whether my child has a mental health disorder?
What happens after my child is evaluated?
Q. Do you accept insurance?
A. Fees are due at the time service is provided. Dr. LoPinto is not contracted with any insurance companies. However, many insurance plans provide Out-Of-Network (OON) coverage for mental health services. OON coverage applies to non-contracted providers such as Dr. LoPinto. Typically, insured policyholders with OON coverage will need to first meet a specified deductible after which the insurance plan will reimburse the policyholder 50%-80% of the Usual and Customary Rates (UCRs) for each service provided. Dr. LoPinto's service fees are within the UCRs. After your payment is received at each appointment, you will be given a paid itemized bill with all information required by the insurance plan (e.g., your child's diagnosis and treatment information) to submit to your insurance plan for reimbursement directly back to you. For example, if you have OON coverage and meet your deductible, your insurance plan will likely reimburse you $50-$80 of the Individual Psychotherapy fee of $100 leaving you with an out-of-pocket expense of $20-$50.
Q. How do I find out if I have Out-of-Network (OON) coverage, how much my deductible is, and how much I will be reimbursed?
A. You can easily find out if you have OON coverage, what your deductible is, and what percent of the UCRs they will reimburse to you by calling the member services number on your insurance card and speaking to a customer service representative. Sometimes, the representatives may ask you for the providers name, Licence number, and taxpayer ID number. You may contact Dr. LoPinto for this information. However, understanding that you may not have the time to call your insurance plan, or may not feel comfortable calling yourself, you can contact Dr. LoPinto, provide her with your information, and she will be happy to call your insurance plan for you.
Q. Why doesn't Dr. LoPinto participate in my insurance plan?
A. Dr. LoPinto realizes that mental health services can be costly over time. For this reason, Dr. LoPinto makes every effort to keep service fees within Usual and Customary Rates (UCRs). Dr. LoPinto chooses not to be contracted with insurance plans because she does not agree with current health care practices that require contracted providers to record and disclose a child's mental health diagnosis and detailed personal health information about the child, such as sensitive information revealed in each session, in order to be paid.
Sometimes a child may be experiencing difficulties at home and/or at school that do not meet the criteria for a mental/psychological disorder, but that would benefit greatly from psychological interventions. However, in order to be reimbused from an insurance plan, the insurance company requires that there be a medical necessity for treatment and therefore REQUIRES that a mental disorder (diagnosis) be documented and disclosed to them. That information then becomes part of your child's permanent medical history. For this reason, Dr. LoPinto leaves the decision to parents to decide if they want to submit paid bills with their child's diagnosis and treatment information in order to be reimbursed.
Q. How will Dr. LoPinto determine whether my child has a mental health disorder?
A. Dr. LoPinto believes in conducting a THOROUGH, COMPREHENSIVE diagnostic evaluation before diagnosing a child with a mental health disorder. Dr. LoPinto is a parent herself, and understands how difficult it may be to find out your child has a mental health disorder. Therefore, she takes the responsibility of accurately diagnosing your child VERY seriously and will typically take FOUR sessions to determine if your child has a mental health disorder. The four sessions will include a thorough diagnostic interview with you and your child, direct observations of your child at home and/or at school, standardized behavior rating scales to accurately assess whether or not your child's behaviors are age appropriate, and a thorough review of your child's medical, psychological, and academic records (Yes, Dr. LoPinto actually reads every line of every record you authorize her to obtain and will ask you many questions to clarify the information further!). Then, and only then, will Dr. LoPinto decide if your child truly meets the diagnostic criteria for a mental health disorder.
Q. What happens after my child is evaluated?
A. After Dr. LoPinto completes your child's diagnostic evaluation, she will explain her findings and offer her treatment recommendations which will likely include components of Cognitive-Behavioral Therapy (CBT). Upon your agreement, you will then be provided with a written treatment plan, which will include agreed upon symptoms to be treated, long- and short-term goals, an estimation of how many sessions will be needed to reach each goal, specific treatment strategies, and how progress will be monitored/evaluated. Approximately every 10-12 weeks, Dr. LoPinto will review your child's treatment plan and progress to date, and will revise the treatment plan if necessary, with your consent.