Intake Form – NESCA

PLEASE READ THESE INSURANCE FAQs CAREFULLY BEFORE COMPLETING THIS FORM

Does NESCA take insurance for neuropsychological evaluations?

For neuropsychological evaluations, Drs. Asher, Burns, Creedon, Currie, Dautoff, Gibbons, Hess, Milana, Rodriguez, and Talamo are providers to Blue Cross Blue Shield.

NESCA does not bill any other insurance companies directly for evaluations. If you wish to seek partial reimbursement from your insurer, we will provide you with a detailed invoice (i.e. a superbill) at the conclusion of the evaluation.

Does insurance cover the full neuropsychological evaluation fee?

No. Health insurance companies provide coverage only for testing that meets their "medical necessity" criteria.

All evaluations at NESCA include testing that insurers consider "educational" and therefore do not fund. For this testing and subsequent feedback, you will be billed a separate fee for Educational Program Planning and Consultation Services.

If you have questions about your neuropsychological evaluation coverage, we encourage you to speak with your health insurance provider prior to completing this intake.

Does insurance cover transition services?

Transition consultation, planning, and assessment services are all considered "educational" services and are not covered by most insurance plans.
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Insurance Information

NESCA does not accept Mass Health. For neuropsychological evaluation, NESCA is able to direct bill BCBS. We do not direct bill for any other services or any other insurance companies. IF YOU INTEND TO USE BCBS INSURANCE, PLEASE COMPLETE ALL FIELDS BELOW. Please note that you are responsible for knowing the benefits, limitations, and responsibilities of your health insurance plan.
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Reason for Referral: Please describe your concerns or reason for requesting evaluation and/or services at this specific time.*
Which services are you interested in? *Please note that NESCA only bills insurance (BCBS) for neuropsychological services.*

Neuropsychological EvaluationPsychological (Projective) TestingInternational EvaluationSchool Observations and ConsultationsOccupational Therapy Assessment, Consultation and/or TreatmentTransition AssessmentCareer/Vocational AssessmentTransition Consultation and Planning (Select for consult, planning, OR if you need to determine whether assessment is necessary)Parent Coaching or ConsultationStudent or Adult Coaching (Real-life Skills, Executive Function, Career, College, etc.)Psychotherapy- Remote only (ages 14 and older)Psychoeducational CounselingOther
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