Insurance Participation

......when experience matters

Articles
BCBA-D What is it?
BCABA - Independent?
How to answer when
insurance says ABA
is experimental.
EIBI and Cost
"Certified" Therapist?
"The Autism Puzzle"
What is BCBA anyway?
What is the ABLLS-R?
ASD Evaluations
SLP & ABA
Sign vs. PECS
Diagnosis-Eligibility
Release Records
NAS on Autism
Hire an ABA?
ADHD or Sleep?
Aggression
Communication
FBA
NASP & FBAs
Rx data sharing
More than Rx needed
Social Maladjustment
A good Psych Report?

Links
Aspergers
Autism
Support Groups
Behavioral
Consumer Resources
Education
Learning Disorders
Medical
Psychology
Specific Disorders

We will assist you in every way in seeking Out-of-Network reimbursement for services not covered by one of the companies listed. Upon request, a detailed statement of fees is provided for patient's submission to insurance companies for reimbursement.

We are unaware of any major insurance carrier in Georgia, other than the Active Duty Military's ECHO program for TriCare and a very specific program for ABA Services through United Healthcare, that will reimburse for In-Home ABA services. We are active participants in both TriCare and United Healthcare' ABA Programs. Other States have "Autism Mandates" and insurance policies written in those States are required to cover ABA. It is essential to know in which State your policy is written in order to determine whether you may have ABA coverage. We are always open to learning about new policies or changes in existing practices by insurers. Attached is our check sheet for investigating whether your insurance policy may cover In-Home ABA services.

Please note that most insurance companies do not cover psychological testing for developmental delays or learning issues, as they deem these services 'educational' rather than 'medical'.

Some insurance plans do cover a portion of costs for 'out of network' providers. Please check with your insurance company for further information.

Dr. Robert Montgomery is an accepted psychologist for the following insurance plans (for more information on any program please click on the logo for your insurance company).

Insurance Notes

You must notify us prior to the beginning of service that you are planning to use an insurance carrier to pay for your services. Once you have elected to pay out-of-pocket we are not obligated to bill your insurer or reimburse you any difference between what you insurer would have paid and what you have paid for the services rendered.
BC&BS of GA, and from the information that they have provided to us ALL BC&BS plans, now requires pre-approval for ALL psychological testing. This essentially means that you must make a 1 hour appointment for an interview, records review, and initial determination of need for testing. Then a request must be faxed to BC&BS of GA and then we have to wait for their determination based on the request. We can NOT appeal their denial for you. If denied your Medical Insurance will NOT cover any evaluation done. You can elect to proceed with the evaluation as a self-paying patient. If you later submit the invoice for reimbursement and are reimbursed by BC&BS this is between you and BC&BS.
You must notify us of ALL insurance policies in place prior to service for us to be able to properly bill insurance for our services. ANY failure to disclose insurance in force at the time of service can result in your being responsible for 100% of all fees associated with our services regardless of whether we are a participating provider under ANY of your plans.
It is possible to have Major Medical coverage with an Insurance Carrier, for example BC&BS, and NOT to have ANY mental health (or Behavioral health) coverage on that policy. We make no representation to knowing what, if anything, your particular insurance plan will cover. It is best to contact your benefits manager and inquire if you have any questions at all about your plan's coverage for our services. Insurance is a relationship between you, your employer, and the insurance carrier.
Many insurers subcontract their Mental Health coverage to another company. These companies are in the business of administering Mental Health coverage for many mid-size and small insurers. Please check with your insurer or HR department to see if your Mental Health coverage is administered or provided by some other Company than provides your Major Medical coverage. BC&BS has been known to subcontract the mental health coverage to Cigna among others. If they do so you are NOT covered under the PPO contract for BC&BS and we can not do "in-network" billing for our services - sorry - and you remain responsible for all fees associated with our services.
Blue Cross & Blue Shield of Georgia PPO provider. BC&BS is a loose affiliation of state-based health plans, because Dr. R. Montgomery is a PPO provider in Georgia he is typically covered under BC&BS PPO plans of other states as well - when in doubt contact your HR department or BC&BS of your state for additional information.
We are committed to serving our Military Families therefore, Dr. Robert Montgomery is a participating Psychologist under TriCare Southeast and Dr. Christine Montgomery, Mr. Joe Cermak, and Ms. Rachael Coplin are participating as BCBAs in the ECHO and ECHO Demonstration programs.
APS & United Healthcare - PLEASE NOTE - We have resigned from APS & United Behavioral Healthcare (the Mental Health division of United Health). We did not take this action lightly. We are not accepting new patients using APS, United Healthcare or United Behavioral Healthcare. Current patients - our obligations under APS & UBH ended December 7, 2006. EXCEPTION: United Healthcare policies that include ABA coverage - we accept patients with UBH Coverage for ABA services on a case-by-case basis, please inquire.

Medicaid of Georgia - certified as a psychologist provider for Medicaid of Georgia. We currently are only accepting Traditional SSI-based Medicaid. We are not accepting patients with CMO administered Medicaid (Peachstate, Amerigroup, or Wellcare). Please contact us regarding our acceptance of Medicaid in your particular instance.

Please contact us regarding our acceptance of Medicaid in your particular instance.

PAYMENT POLICY
Payment is expected at the beginning of each office visit. We welcome the opportunity to discuss any special arrangements you deem necessary prior to the delivery of services. If you are insured under a managed care contract with which we are allowed to participate, your company requires that you pay your co-pay and present your insurance card at each office visit. Cancelling appointments without adequate notice will result in a missed appointment charge. Visits with your doctor require time and expertise and are therefore the office requires at least two day cancellation notice of confirmed consultations, otherwise a missed appointment charge will be charged. Extenuating circumstances will be considered. Insurance does not pay for missed appointments, you remain responsible for this fee regardless of your insurance plan or our participation.
We make no representation to knowing what, if anything, your particular insurance plan will cover. It is best to contact your benefits manager and inquire if you have any questions at all about your plan's coverage. We are not obligated to know if your plan will cover the services we provide - this is why we strongly urge you to inquire with the appropriate people if you have any doubts whatsoever regarding your insurance coverage. We will do everything we can to appropriately facilitate accessing your insurance coverage for services rendered at Reinforcement Unlimited, LLC. You must notify us prior to the time of service that you are planning to use an insurance carrier to pay for your services. Once you have elected to pay out-of-pocket we are not obligated to bill your insurer or reimburse you any difference between what you insurer would have paid and what you have paid for the services rendered. Contacting our office by phone is insufficient to ensure that we have accepted you as a Medicaid patient. Regardless of your insurance situation, you remain responsible for all costs associated with service not covered by your insurance.

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***In Accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we have posted our privacy practices on our web site. ***

Our publications (online, email, or print) do not provide medical advice or a professional service. We are not engaged in providing any medical or professional advice or services through the publication or distribution of articles or comments on this site. Individuals with suspected or diagnosed disorders or syndromes, or any condition discussed on this site, should consult with us or a physician and other qualified professionals for advice concerning diagnosis or treatment.