DTS currently accepts the following third-party payer sources:

• Aetna

• Blue Cross Blue Shield (BCBS)

• Cigna

• Lyra EAP

• Tricare (Certified)

• United Healthcare (UHC or Optum)

Insurance coverage varies by individual clinician, type of service, and type of insurance plan.

*A note on Tricare: We are currently considered Certified with Tricare, which is different than in-network or out-of-network. This means that we are on Tricare’s list of approved providers that can typically provide services to Tricare members at an equivalent or slightly higher rate than in-network providers. Because of our Certified status, we require a PCM referral before scheduling services.

Most therapy sessions are 53-60 minutes in duration. For clients not utilizing insurance and paying out-of-pocket, our rates are as follows:

• Fully licensed therapist (LPC, LCSW, LMFT, Psychologist) - $150

• Provisionally licensed therapist (LPC-A, LMSW, LMFT-A) - $75-100 with sliding scale rates available

*These are our standard base rates. Costs may vary based on length of session (e.g. 90 minutes) or type of session (e.g. couples).

For clients not utilizing insurance and paying out-of-pocket, our testing rates are as follows:

• Autism testing - $2000

• Diagnostic testing - $1750

• IQ testing - $1000

• Cognitive and Learning Disorder testing - $1500

We are unfortunately limited to providing each client utilizing insurance with only one form of psychological testing per policy year. This restriction typically applies to autism evaluations and diagnostic testing. In most instances, we can also conduct IQ testing and cognitive/learning disorder evaluations on a private pay basis in the same policy year. We understand the inconvenience this may cause, and we appreciate your understanding as we navigate these restrictions to ensure the best care for our clients.

We do not accept insurance for IQ testing. Because IQ testing alone is typically not associated with a specific medical or psychological diagnosis, it often does not meet medical necessity criteria for reimbursement required by most insurance providers. While IQ testing can provide valuable insights into cognitive abilities, it is generally considered an elective service.

For cognitive and learning disorders testing, we accept only Aetna, Cigna, and private pay. This testing is often not covered by insurance. We will check benefit eligibility, but coverage is not expected or guaranteed, in which case the client is financially responsible. 

*These are our standard base rates. Costs may vary based on the duration of testing (e.g. if standard time must be increased significantly) and/or add-on services (e.g. if additional assessments are required.)

DTS does not accept insurance for immigration evaluations. Our current rate is:

• $1100

*These are our standard base rates. Costs may vary based on duration (e.g. if standard time must be increased significantly) and/or add-on services (e.g. for expedited processing.)

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 healthcare 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:

Emergency services

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.

Additionally, Texas law protects patients from surprise medical bills in emergencies and when a patient receives covered medical services from an out-of-network provider at an in-network facility. The law applies to state-regulated insurance plans, including the state employee or the teacher retirement systems. This law does not apply to nonemergency healthcare or medical services when a patient elects in advance and in writing to receive those services from an out-of-network provider and when the out-of-network provider provides the patient with a written disclosure.

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 directly.

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 U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227)

• The Texas Department of Insurance Consumer Help Line at 1-800-252-3439

• The Texas Behavioral Health Executive Council at 512-305-7700

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.

Visit https://www.tdi.texas.gov/tips/texas-protects-consumers-from-surprise-medical-bills.html or https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html for more information about your rights under Texas law.