BRAINS attempts to work with insurance companies whenever possible. The insurance companies determine credentialing status based on many factors, including degree, years of experience, and the need for their patrons to receive services in a particular area. At least one of our clinicians is paneled with most major insurance companies, including Priority Health, Blue Cross Blue Shield of Michigan, PPOM, ASR, Cigna, ValuOptions/BCN, CompCare, Aetna and others. Some insurance companies will make exceptions on a case by case basis. We attempt to work with most companies for coverage of the services provided.

Unfortunately, there are times when insurance companies can deny payment of claims, even after initial authorization. This is out of the control of BRAINS. Further, it is common for families to have a deductible before the insurance company will begin paying on a case. The family is responsible for the deductible and payment of cases that have been denied.

Further, several companies do not offer an affordable payment rate to compensate for the clinical time and expertise required to complete an evaluation or for the costs of treatment. In these situations, BRAINS is unable to bill insurances and will have to work with the family for self-pay options. Also, insurances have become more stringent in the area of testing. As an example, ValuOptions/BCN are stringent on the allowance for testing/evaluation, but tend to be more flexible with therapy approvals.

Many of the specialty services are challenging to gain coverage or receive fair payment. Neurofeedback, although harboring strong potential as an intervention, has not been covered at a rate to compensate for the technical equipment, expertise of the staff, or other costs. As such, this is a service that is a self-pay option only at this time. BRAINS will print a walk-out statement for the family to attempt to recover possible payment/reimbursement from insurance. BRAINS will continue to work with insurance companies to have specialty services covered as a benefit and to be paid at a reasonable rate.

Major Insurance Companies with Clinicians on Panel:

Blue Cross Blue Shield of Michigan
Priority Health
PPOM
ASR
ValuOptions
BCN
Magellan
CompCare
Aetna
Cigna

We do not work with Straight Medicaid at this time, but do work with Priority Health Medicaid. If there is a need for services with a Straight Medicaid product, we do work with Network 180 on a case by case basis for approvals. This has worked well for neuropsychological evaluations and consultations.

If you have questions about coverage, please contact your insurance provider or refer to your insurance manual. Our Support staff can also be of assistance and know which plans most of our clinicians have been paneled. Still, there are exceptions, so it would be beneficial to call to seek clarity when there are questions.