Insurance Accepted at BrainWorks Behavioral Health

Understanding your insurance coverage should not make it harder to get the answers or care you need. BrainWorks Behavioral Health works with a range of insurance plans and offers multiple pricing options for testing and other behavioral health services.

Our team provides comprehensive psychological and neuropsychological evaluations for children, adolescents, and adults throughout Southern California, including evaluations for ADHD, autism, learning disorders, memory concerns, neurodevelopmental conditions, and traumatic brain injuries.

Insurance benefits vary by plan, service, provider, and location. Our team can help you determine the next steps based on your insurance and the services you are seeking.

Insurance Plans Accepted

BrainWorks Behavioral Health is contracted with a number of major health plans serving individuals and families throughout Southern California. Coverage for psychological testing, neuropsychological evaluations, TMS, and other services depends on your specific benefits and the requirements of your plan.

Sharp Health Plan

Sharp Health Plan primarily serves members in San Diego County, making it particularly relevant to patients using our San Diego and Chula Vista locations. Members may have different behavioral health benefits depending on their specific plan, including employer-sponsored, individual, family, and Medicare options.

TRICARE

TRICARE provides healthcare coverage for eligible active-duty service members, National Guard and Reserve members, retirees, and their families. Because referral and authorization rules can differ among TRICARE plans, the steps for accessing psychological or neuropsychological testing may depend on the type of TRICARE coverage you have.

Medicare

Medicare Part B includes coverage for certain outpatient mental health services, including diagnostic services when Medicare’s requirements are met. For psychological or neuropsychological testing, coverage is generally tied to the clinical purpose and medical necessity of the evaluation rather than testing performed solely for non-medical purposes.

Cigna Healthcare

Cigna offers behavioral health benefits through many of its employer-sponsored and individual health plans. Members seeking psychological or neuropsychological testing should check the behavioral health portion of their benefits, as evaluation services may be handled differently from routine office visits or therapy.

Aetna

Aetna offers commercial health plans as well as Medicare plans, so benefits can look different from one Aetna member to another. For diagnostic evaluations, the reason testing is being requested and the services involved can affect how the claim is reviewed.

UnitedHealthcare

UnitedHealthcare members can use eligible benefits for psychological and neuropsychological services. For diagnostic testing, the scope and clinical purpose of the evaluation help determine which services are appropriate and how they are billed.

Blue Shield of California

Blue Shield of California offers individual, family, employer, Medicare, and Medi-Cal coverage in California. The type of Blue Shield plan you have matters when determining the network and behavioral health benefits that apply to psychological or neuropsychological services.

Desert Oasis Healthcare

Desert Oasis Healthcare serves the Coachella Valley and surrounding desert communities, making it particularly relevant to patients near our Rancho Mirage location. Desert Oasis operates as a medical group rather than a traditional health insurance carrier, so patients may have a separate health plan in addition to Desert Oasis appearing in their coverage information.

Regal Medical Group

Regal Medical Group is a physician network rather than an insurance carrier itself. Patients affiliated with Regal may therefore have a separate health insurance plan, with the medical group involved in coordinating certain referrals, authorizations, and specialty care.

Optum

Optum administers behavioral health benefits for a variety of health plans and employers. This means a patient may have another company named as their primary health insurer while Optum handles the behavioral health portion of the plan, so both pieces of coverage information can be relevant when arranging care.

Anthem

Anthem offers several types of health coverage, including employer-sponsored, individual, Medicare, and Medicaid plans. Because the plan type determines the applicable network and benefits, two Anthem members may have different requirements for the same psychological or neuropsychological service.

IEHP logo
Inland Empire Health Plan (IEHP)

IEHP is a public health plan serving residents of Riverside and San Bernardino counties through Medi-Cal and other programs. Its service area overlaps our Riverside and Rancho Cucamonga locations, providing a local option for members seeking psychological or neuropsychological evaluation.

Carelon Behavioral Health

Carelon Behavioral Health administers mental and behavioral health benefits for health plans, employers, and other organizations rather than functioning only as the name patients see on their primary medical insurance. If Carelon manages your behavioral health benefits, it may be the relevant network for services even when another insurer appears on your health plan.

Molina Healthcare

Molina Healthcare has a significant presence in government-sponsored healthcare, including Medi-Cal and Medicare plans in California. Patients should identify which Molina plan they have when seeking testing, since benefits and network requirements are tied to the specific coverage program.

Community Health Group

Community Health Group is a local nonprofit health plan serving San Diego County, including Medi-Cal members. Its regional focus makes it particularly relevant to families seeking Community Health Group autism testing, ADHD evaluations, or neuropsychological testing through our San Diego-area locations.

L.A. Care Health Plan

L.A. Care Health Plan is a publicly operated health plan serving Los Angeles County, including a large Medi-Cal membership. For patients searching for L.A. Care ADHD evaluations, autism testing, or neuropsychological testing, our Los Angeles location provides a geographically relevant starting point for accessing care.

Does Insurance Cover TMS?

TMS is covered by many health insurance plans, particularly for patients with depression who have not experienced sufficient improvement with other treatments. Insurers may look at treatment history when determining eligibility for TMS coverage, which can be used toward qualifying treatment at our San Diego location.

Do I Need a Referral or Prior Authorization?

Referral and prior authorization requirements differ between insurance plans and services.

Some patients may be able to schedule directly, while others may need a referral from a primary care provider or authorization from their health plan before receiving certain services. Evaluations and treatments may also have different requirements even when they are covered by the same insurance plan.

Providing your insurance information when you contact us allows our team to identify any requirements that should be addressed before your appointment.

Insurance Coverage Across Southern California

Our accepted insurance plans help make care accessible across eight Southern California locations:

With offices across the region, patients can seek care at the location that is most convenient for them. Explore your nearest location to learn more about the services available and how to schedule an appointment.

Using Out-of-Network Insurance at BrainWorks Behavioral Health

You may still be able to use insurance benefits even if your plan is not listed above.

We accept all out-of-network insurance and can provide a superbill after services are rendered. You can submit the superbill to your insurance company to request reimbursement according to your plan’s out-of-network benefits.

The amount reimbursed, if any, is determined by your insurance company. Before scheduling, you may want to ask your insurer about your out-of-network deductible, reimbursement rate, and whether your particular service is eligible for reimbursement.

Frequently Asked Questions

If you have more than one insurance plan, coordination of benefits determines which plan is billed first and whether the secondary plan may cover some of the remaining cost. How the plans coordinate depends on their individual rules and benefits.
Coverage may be more limited when an evaluation is being performed solely for educational, employment, legal, or administrative purposes rather than to address a medical or behavioral health concern. If a school or employer has requested testing, it is helpful to clarify the purpose of the evaluation when discussing coverage.
Let our team know about the change as soon as possible and provide your new insurance information. A new plan can have a different provider network, benefits, authorization requirements, and patient costs, even when your services remain the same.

Verify Your Insurance Before Scheduling

Questions about insurance shouldn’t stand between you and the evaluation or treatment you’re looking for. Connect with us to get started and let our team help make the path from scheduling to care as straightforward as possible.