The information below should be sufficient to establish a Network Gap Extension from your insurance provider. Requesting a Network Gap Extension may be time-consuming and complex, and Dr. Love does not guarantee success. A Network Gap Extension is not required to see Dr. Love, for therapy or an evaluation.
If you elect or do not not receive a Network Gap Extension, the cost of the full amount of the therapy session or evaluation cost will be subjected to your out-of-network benefits.
For out-of-network services, all payments are due during the evaluation. Costs vary by procedure and involvement. Many Gap requests are successful when there is a clear medical history (e.g., head injury, seizures, fetal exposure to drugs) . Success without a medical history (e.g., ADHD, depression) is rare. Insurance companies will NEVER cover academic evaluations.
Single Case Agreements: Insurance companies sometimes ask that the clinician sign a single case agreement. I do NOT sign single-case agreements because they give the insurance company complete power over your treatment, evaluation, and reimbursement. I have had insurance companies deny payment after therapy sessions or an evaluation was completed, which is unfair to you the client and myself.
Steps to Request a Network Gap Extension
1) Have a referral for Dr. Matthew Love from an in-network medical provider (e.g., your primary care physician or neurologist).
2) Call your insurance company and request the Clinical Services Department for a Network Gap Extension for individual, couples, or group psychotherapy. For Evaluations, ask for an Extension for a Pediatric Neuropsychological Evaluation. You may need to request to speak to a supervisor.
3) Be prepared to request the following codes (the codes vary by evaluation type and medical history) when calling your insurance company:
*Psychotherapy:
—-CPT codes—-
Interview: 90719 (Request 1 Unit)
45-Minute Session: 90834
60-Minute Session: 90836
* For Neuropsychological Evaluations (significant medical histories, such as seizures, genetic conditions, head injury, hydrocephalus, fetal exposure to drugs or toxins, lead exposure, extremely low birth weight, extreme premature birth, concussions, sleep apnea, brain surgery, brain tumors, or cancer treatment, etc…)
Diagnosis Code: G93.40
—-CPT codes—-
Interview: 96116 (request 2 units)
Evaluation Support Services: 96132 (request 1 unit), 96133 (request 3 units)
Testing Services: 96136 (request 1 units). 96137 (request 10 units)
*For Psychological Evaluations (no medical history: ADHD, Autism, Anxiety, etc)
Diagnosis Code: Depends on the diagnosis we are primarily exploring, usually the primary concern has something to do with ADHD (F90.2) or Autism spectrum (F48.0).
—-CPT codes—-
Interview: 90791 (request 1 unit)
Evaluation Support Services: 96130 (request 1 unit), 96131 (request 3 units)
Testing Services: 96136 (request 1 units). 96137 (request 7 units)
4) Provider information:
Matthew Love, Psy.D
Matthew Love, Psy.D, LLC
215 Main Street
Westport, CT 06880
Phone: 203-293-6081
Fax: 203-571-4499
NPI #: 1063882025
They may require my practice identification information:
Matthew Love, Psy.D LLC
NPI# 1538791876
Tax ID: 844552868
5) Request the approved authorization in writing.
6) Get the address or fax number for you to send the “Superbill” (see below:)
7) Upon payment at the time of the evaluation Dr. Love will provide you with a “Super bill” that has all of the approved procedural codes and your payments, which you then submit to your insurance company to that they can apply it to your in-network benefits.