Our office will send the requesting party an explanation of the services to be provided (good faith estimate), paper or electronic forms to be completed prior ot the initial appointment, and payment invoices for fees listed in the service agreement.

Patient’s Responsibility seeking Insurance Reimbursement:  Due to the variable nature of insurance reimbursement and authorization, patients are responsible for contacting their insurance carrier for coverage and payment. Please let us know in advance if a pre-authorization is required. Our services are generally approved by insurance carriers for medical necessity but each insurance policy has different criteria for determining this. As a courtesy, we offer first time complimentary direct billing to your insurance company. We also hold a client or parent interview, testing and feedback sessions on different dates of service, so that we have less billing suprises.

Insurance Carrier Disclaimer: “A coverage determination, prior authorization, or certification that is made prior to a service being performed is not a promise to pay for the service at any particular rate or amount. The patient’s summary plan description governs amount payable, as every claim submitted is subject to all plan provisions, including, but not limited to, eligibility requirements, exclusions, limitations, and applicable state mandates.”

We have found that the best way for a subscriber to receive the maximum reimbursement is for the subscriber to confirm their insurance coverage for medical care and their financial responsibilty for their particular plan. We encourage the patient/subscriber to call their insurer to confirm coverages and reinbursements (use the 800 number on the back of card) for Psychological and/or Neuropsychological Services, for the following CPT Codes: 90791 for Psychological Diagnostic Evaluation; 90834 for Psychotherapy; 96116 for Neurobehavioral status exam (medically-based);  96132, 96133, 96136, 96137, 96138, and 96139 for Neuropsychological Testing. Testing sometimes requires Academic Testing, which is not an insurance reimburseable service, as there are no CPT codes for these services.

Due to the limited availability of service hours, we request a $300.00 deposit for the initial diagnostic appointment and consultation. 48 hour notice is required for appointment cancellations. Requests for Expedited or Time Definite (Deadline) Assessments will require a retainer at Forensic Rates. 

 Payments & Costs to the Patient. The costs of our service will depend on the type and complexity of service. Some of our services are not covered by some insurance carriers. The patient is reponsible for service charges not authorized or reimbursed by their insurance carrier. 

Financial Policy. While the patient is responsible for all charges, insurance reimbursements reduce the patient’s cost of the assessment. Many testing charges are reimbursed by insurance carriers. Written Reports for a 3rd party require an additional $500 deposit and charge and will be completed and delivered to the patient upon payment of all charges due. Upon completion and payment for services, any remaining deposit balance will be refunded promptly. As a patient convenience, we accept credit cards, personal checks and cash for deposits and services.

Testing Services with Written Report.  Full payment for services, including report production, must be received before a comprehensive written report is provided.

Hearings or Testimony Participation. A full retainer must be received prior to the scheduling of any hearings or procedures requiring attendance and/or testimony, including preparation time and records review.

Deposits are due before the initial appointment and before the initiation of testing.

No Suprise Billing Act:

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for: Emergency services. If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
These federal laws apply in all states including Colorado and California. The California Health and Safety Code 1799.102 states: “No person who in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission” (Jul 21, 2017).
Certain services at an in-network hospital or ambulatory surgical center. When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed. If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

Existing California law prohibits surprise bills (or “balance billing”) for emergency room care and sets standards for reimbursement to doctors and hospitals for most state-regulated health insurance plans.
When balance billing isn’t allowed, you also have the following protections: You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:
o Cover emergency services without requiring you to get approval for services in advance (prior authorization).
o Cover emergency services by out-of-network providers.
o Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact the HHS No Surprises Helpdesk at 1-800-985-3059, which is the entity responsible for enforcing the federal balance or surprise billing protection laws. 1-800-985-3059 (available 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found. Additional resources about California laws regarding your rights about a surprise bill are also available (call 1-800-927-4357 or go online: https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm).

Filing a Complaint against a psychologist, psychological associate, or registered psychologist

Who May File a Complaint?

Anyone who thinks that a psychologist, psychological associate or registered psychologist has acted illegally, irresponsibly, or unprofessionally may file a complaint with the Board of Psychology. In this document the person who files a complaint is referred to as the “complainant,” and the person against whom the complaint is filed is the “licensee/registrant.”

What Types of Complaints Does the Board Handle?

Complaints under the Psychology Board’s jurisdiction include the following behavior by a psychologist, psychological associate or registered psychologist:

  • sexual contact with a patient
  • violating the patient’s confidentiality
  • providing services for which the individual has not been trained or licensed
  • drug abuse
  • fraud or other crimes
  • false advertising
  • paying or accepting payment for patient referral
  • unprofessional, unethical, or negligent acts
  • focusing therapy on the licensee’s/registrant’s own problems, rather than the patient’s
  • serving in multiple roles, i.e., having social relationships with patients, lending them money, employing them, etc.

California Board of Psychology website: https://www.psychology.ca.gov/consumers/filecomplaint.shtml

Board Of Psychology
1625 North Market Blvd., Suite N-215
Sacramento CA 95834

Colorado Board of Psychology website: https://dpo.colorado.gov/Psychology

Division of Professions and Occupations
1560 Broadway, Suite 1350
Denver, CO 80202

Dr. Mikolic is a licensed psychologist in the state of California (PSY32104) and in the state of Colorado (PSY5187).