Frequently Asked Questions

Developmental Behavioral Pediatrics (abbreviated DBP or DBPeds) is subspecialty within pediatrics that focuses on assessment, diagnosis and providing support for children, adolescents, and their families when there are concerns about differences in development and/or behaviors that are impacting function at home and/or in the community.

Developmental Behavioral Pediatrician’s (DBP’s) are trained and can become board-certified, to evaluate and provide support for kids who struggle with a variety of challenges including delays in development (related to skills in areas such as speech/language, social-emotional, motor, cognitive, adaptive), difficulties sustaining attention/impulse control challenges/hyperactivity, difficulties with picky eating habits, sensory sensitivities, tantrums, toilet-training/toileting issues, etc. Assessing for neurodevelopmental differences such as Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder (ADHD - with predominantly inattentive, hyperactive/impulsive, or combined symptom presentations), Learning differences, etc. can help to explain the reason for the differences and most importantly can help with creating a plan to support and optimize the child’s development and behavior.

Children and adolescents (up to 18 years of age) whose development is not progressing typically/has delays in meeting milestones; is experiencing challenges with attention, emotional regulation, learning, social interactions, making/maintaining friendships, sensory sensitivities, has co-occurring anxiety symptoms, tantrums, or other behavioral challenges. If a child/adolescent has a prior diagnosis of a neurodevelopmental difference and is looking to establish care and/or to obtain further assessment, then they are appropriate for a new patient evaluation visit. A child does not need to have a specific diagnosis to schedule an evaluation. An evaluation can help with determining if a diagnosis is appropriate and what supports the child/adolescent could benefit from.

Children or adolescents who have multiple prior psychiatric hospitalizations, suicidal and/or homicidal thoughts or actions, visual or auditory hallucinations, major depression with or without episodes of mania, or difficulties with substance abuse/addiction are best supported by a Child & Adolescent Psychiatrist and/or Addiction Medicine Specialist. Children or adolescents who are experiencing uncontrolled seizures or other primarily neurologic concerns should be seen by a Pediatric Neurologist for care and management of those concerns.

As a Developmental-Behavioral Pediatrician, Dr. Cohen’s care will focus on developmental and/or behavioral concerns as part of your child’s care team, but she will not replace your child’s regular Pediatrician. General Pediatric services such as immunizations, regular well child check-ups, management of medical conditions, health concerns, and sick visits need to be done through your child’s Primary Care Pediatrician. Dr. Cohen will evaluate, discuss, and make recommendations regarding the specific behavioral/developmental concerns you have for your child. As part of your child’s care team, Dr. Cohen will communicate with your child’s Primary Care Pediatrician as well as any involved specialists as needed.

No. Dr. Cohen’s office uses a cash-based direct care/fee-for-service model (for details please see Pricing). We do not accept or bill insurance. However, our office will provide you with a superbill that you can submit directly to your insurance as claim for possible reimbursement for care from an out-of-network provider. It is the patients’ responsibility to submit these claim forms to their insurance company. Contact your insurance company to inquire about their policies related to reimbursement via the use of a superbill.

Insurance plans with out-of-network coverage, PPO, or POS plans are more likely to provide reimbursement compared to HMO or Medi‐Cal plans. Each insurance company reimburses differently and a refund for the full payment amount is not guaranteed. Contact your insurance company for more information about your specific plan.

When you choose to have your child seen at our Developmental-Behavioral Pediatrics Private Practice, you will receive a document called a "superbill" after your visit. This document is an important tool for those who wish to seek reimbursement from their insurance company for services provided by an out-of-network provider like me.

What is a Superbill?

A superbill is an itemized form that details the services provided during your visit. It includes essential information such as:

• The date of service

• Description of services provided

• Diagnosis codes (ICD-10)

• Procedure codes (CPT)

• The total amount charged for the services

General Instructions on How to Submit a Superbill to Your Insurance Company

1. Contact Your Insurance Provider: Before submitting a superbill, contact your insurance company to understand their specific process for out-of-network claims. They can provide you with the necessary forms and instructions.
   

2. Complete the Claim Form: Fill out any required claim forms provided by your insurance company. Attach the superbill to this form.
   

3. Submit the Documents: Send the completed claim form and the superbill to the address specified by your insurance company. This can often be done via mail, fax, or through an online portal.
   

4. Follow Up: After submission, follow up with your insurance company to ensure they have received your claim and to inquire about the processing timeline.
   

Reimbursement Rate Ranges

Reimbursement rates for out-of-network services can vary widely depending on your insurance plan. Typically, insurance companies may cover a percentage of the "usual and customary" rates for services, which can range from 50% to 80%. It's important to check with your insurance provider to understand your specific coverage and any deductibles that may apply.

Additional Resources

• Insurance Plan Documents: Review your insurance policy documents for details on out-of-network benefits.

• Insurance Customer Service: Utilize the customer service line of your insurance company for any questions or clarifications.

• Reimbursify: Reimbursify is a service designed to simplify the process of submitting out-of-network health insurance claims, which can be particularly helpful for parents using a superbill. Reimbursify can help with simplifying superbill submissions through their website and/or app. Within the app you can submit claims by taking a photo of the superbill and entering some basic information. The app also provides automated form filling, claim tracking/notifications. Customer support is available if you have questions. In my experience submitting a superbill has not been difficult once you know what to do but using a company like Reimbursify may streamline the process of accessing out-of-network benefits for you and your family and could result in more accurate and quicker reimbursements.

We hope this information helps you make an informed decision about your child's care. If you have any further questions, please feel free reach out and ask.