“When we do the best we can, we can never know what miracle is wrought in our life or the life of another.”
– helen keller
When should I seek an evaluation for myself or my child?
Please see Dr. Manfredi’s blog post on when to seek an evaluation for yourself or your child. You may also find Dr. Manfredi’s post and video on the differences between public and private evaluations helpful, as well. In summary, the following symptoms and situations may suggest a need for an evaluation:
The following symptoms may suggest a need for an evaluation: difficulties in learning; not achieving expected levels of progress; problems with attention and concentration; weak organizational skills; missing/delayed developmental milestones; delays in communication or social skills; poor behavioral or emotional regulation; memory difficulties; a major change in mood, behavior or learning; or difficulties getting along with others.
The following situations may suggest a need for an evaluation: special education eligibility, need for accommodations on standardized testing, need for accommodations in college or in the workplace, guardianship determination, disability determination, educational/treatment planning, diagnostic clarification, starting a career or educational program, or changing a career or educational program.
How soon can I come in for an evaluation?
Consultation appointments are generally available within 1-2 weeks. Because of the amount of time required for each evaluation appointment, they are typically available in 6-8 weeks from the time you call. Please note that certain times of the year are busier and may have longer wait times, while less busy times may have shorter wait times. Our wait times are much shorter than many hospital and medical-based practices. Reports are typically available 2-3 weeks after all testing has been completed.
Does the practice accept insurance?
Dr. Manfredi is an in-network provider with CareBridge EAP, Modern Health, and Quest Behavioral Health only. Our clinicians are not in-network with any other health insurance plans at this time. If your plan has out-of-network reimbursement, you may be eligible for partial reimbursement according to the specific requirements and coverage limitations of your plan. Our office can provide you with a billing statement that includes all procedural and diagnostic codes that can be submitted for reimbursement. Our office is not able to submit out-of-network claims directly to your insurance company. If you would like assistance with applying for out-of-network reimbursement, our office recommends using Reimbursify. Unfortunately, we are not able to tell what your potential reimbursement might be, as this depends on multiple factors related to your specific health insurance plan (e.g., deductibles, coverage limitations, insurance plan reimbursement rates, and co-insurance or cost-sharing factors).
Please note that career assessments/consultations, educational evaluations, disability evaluations, school meetings/observations, or evaluations for forensic purposes are not eligible for reimbursement through health insurance, as they do not meet medical necessity criteria.
Am I able to use EAP benefits at the practice?
Dr. Rosemarie Manfredi is credentialed with Carebridge EAP and Modern Health. If your employer offers EAP services through Carebridge or Modern Health, please contact your HR department for a referral to our practice. All EAP referrals must be arranged through Carebridge or Modern Health; our office cannot accept EAP referrals directly from clients/patients.
Does the practice offer sliding scale fees?
For those experiencing financial hardship, Dr. Manfredi participates in Open Path Collective. As such, Dr. Manfredi offers a limited number of reduced-fee therapy and counseling appointments ($60/session) to Open Path members. Please contact the office to determine if there are Open Path appointments available.
Our licensed clinicians all offer flat rates for psychological, educational, or neuropsychological assessment and evaluation services. By offering a flat rate fee for evaluations, our office provides transparency and predictability in pricing. We allow assessment and evaluation fees to be divided into two payments (50% at the first visit and 50% when the evaluation is concluded). If you require reduced-fee psychological assessment services, there are a number of local doctoral training programs that offer psychological testing administered by advanced doctoral students under the supervision of licensed psychologists.
What are your fees?
Fees for all services are listed on the website. Please click services on the menu above and then choose the service you are interested in.
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
(OMB Control Number: 0938-1401)
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:
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.
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 protection 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.
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
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- 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.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact: The Pennsylvania Insurance Department by calling 1-877-881-6388 or visiting: https://www.insurance.pa.gov/Coverage/health-insurance/no-surprises-act/Pages/default.aspx
Visit https://www.cms.gov/files/document/model-disclosure-notice-patient-protections-against-surprise-billing-providers-facilities-health.pdf for more information about your rights under Federal law.