Psychological evaluations for benefits applications that fall outside the scope of health insurance coverage. These evaluations do not meet the definition of medical necessity and are not used to treat a disease.
What Is a Benefits Evaluation?
A benefits evaluation is a psychological assessment conducted for the purpose of supporting a benefits application — such as a private disability claim, an employer-sponsored benefit program, or another non-government benefits request.
Unlike evaluations ordered to diagnose or treat a mental health condition, these assessments serve an administrative or legal purpose. Because they do not meet the insurance definition of medical necessity and are not used to treat a disease, they are not covered by health insurance.
Benefits evaluations are self-pay only. No insurance will be billed, and no insurance authorization will be sought for this service.
Why Insurance Does Not Cover This
No Medical Necessity
The evaluation is not being ordered to diagnose or treat a medical or mental health condition. It does not meet the insurance definition of medical necessity.
Not for Treatment of a Disease
The purpose of the evaluation is to document functioning for a benefits application — not to guide treatment of a disorder or illness.
Not Listed Under Your Plan
Benefits-related evaluations are generally excluded from health insurance coverage because they serve an administrative or legal purpose rather than a clinical one.
This Is Not the Same As…
It is important to understand that the benefits evaluations offered here are completely separate from government-ordered or government-paid disability evaluations. The following are not what this service provides:
SSA Disability Evaluations
Consultative evaluations ordered and paid for by the Social Security Administration as part of the federal disability determination process. These are at no cost to you.
VA Compensation & Pension Exams
C&P evaluations ordered by the Department of Veterans Affairs to determine service-connected disability ratings. These are arranged and paid for by the VA.
Workers' Compensation Evaluations
Evaluations ordered within the workers' compensation system to assess work-related injuries. These are paid for by the employer's insurance carrier or the workers' comp board.
What to Expect
Your evaluation will include a comprehensive clinical interview and psychological testing as warranted by the nature of your benefits application. The length of the evaluation depends on the complexity of your case.
Upon completion, you will receive a detailed psychological report documenting your current functioning, clinical findings, and diagnostic impressions. This report is prepared to support your benefits application with the requesting entity.
Please bring a valid government-issued photo ID, any assistive devices you regularly use (glasses, hearing aids, etc.), and take all prescribed medications as normal on the day of your appointment.
Frequently Asked Questions
Why won't my insurance cover this evaluation?
Health insurance covers services that are medically necessary — meaning they are needed to diagnose or treat a condition. Benefits evaluations are performed for administrative or legal purposes, such as applying for disability benefits through a private insurer or employer program. Because the evaluation is not treating a disease, insurance companies consider it outside the scope of covered services.
How is this different from an SSA or VA evaluation?
SSA consultative evaluations and VA Compensation & Pension exams are ordered and paid for directly by those government agencies. Benefits evaluations offered here are self-pay services requested by individuals who need documentation for private disability claims, employer benefit programs, or other non-government purposes.
What does the final report include?
You will receive a comprehensive psychological report documenting your current level of functioning, relevant clinical findings, and any diagnostic impressions. The report is written to support your benefits application with the requesting entity.
How long does the evaluation take?
Most benefits evaluations require several hours of face-to-face assessment, including a clinical interview and psychological testing. Total time varies depending on the complexity of your case, which is why services are billed at $200 per hour with a $1,300 minimum — whichever amount is lower.
Ready to Schedule?
Contact our office to schedule your benefits evaluation.