Medical Reasons for Neuropsych Eval?

[HeidiD]

Hi All,

 

My insurance company (like most) doesn't cover testing for educational purposes, only medical. What are some medical reasons for a neuropsych eval that would justify testing as a medical issue for insurance purposes?

 

Asking this because one of my kids is soon to be tested for CAPD without a full neuropsych eval (only cognitive testing, which is what the audiologist requested and therefore all that's likely to be covered at this point) and I would really like him to have a full neuropsych eval while he's at it. Big bucks, out-of-pocket. :tongue_smilie:

 

Is ADD considered a medical issue? Dysgraphia? Dyslexia? Behavioral/psychological issues? I'm looking for something possibly applicable that can be added as a medical reason to necessitate a broader scope of testing.

[Guest]

This is really a national tragedy -- that we can't get our kids tested so that we can best work with them, with full knowledge of their neurological issues, unless we have thousands of dollars sitting idly by.

 

Having borrowed money to pay for my dd's testing because our insurance would not cover it, I can tell you, sadly, dysgraphia and dyslexia are not considered medical issues. Rather bizarrely, neither are many vision problems. I don't know about ADD; I only know my daughter's Asperger-related behaviors were not considered medical issues unless she required psychiatric drugs or hospitalization, at which point our insurance company would be all too happy to help out. :confused:

[HeidiD]

I only know my daughter's Asperger-related behaviors were not considered medical issues unless she required psychiatric drugs or hospitalization, at which point our insurance company would be all too happy to help out. :confused:

 

So even the diagnosis wasn't covered?

 

My daughter (aspergers) was covered, but the problem was finding someone who would take our insurance. The majority of them in our area won't take anything but Blue Cross or cash (because they are few in number, they can afford to be very choosy, and who can blame them for not wanting to waste their time on insurance company-related red tape). And, there's only one neuropsych within a 150 mile radius of us who belongs to our insurance company's (Tricare) approved list, in this, a major metropolitan area! Just another example of government health care in action. :tongue_smilie:

 

You're right, it's a tragedy - not enough providers, and too costly for many people to afford.:tongue_smilie:

[Guest]

She'd actually been diagnosed with Asperger's at age eight; this was a follow-up type of thing at age eleven when her dysgraphia was getting much worse and it was becoming more of a handicap educationally, and she was becoming anxious in general as puberty approached. So the full neuropsych evaluation was not covered. In a weird way it was almost funny watching everyone pass the buck: no, it's not medical, it's academic and the schools should pay for it; no, she reads above grade level so it's not academic and the medical insurance should pay; we don't believe social skills therapy helps anybody but we'll pay for psychiatric institutionalization.

 

I'm happy to report, though, that the neuropsych's detailed discussion and suggestions have been pure gold and worth every penny we had to spend. I wonder whether the new categorization of Asperger's under the general autism label will make a difference in terms of coverage for evaluations now. We had ours done long before this change.

[HeidiD]

 

I wonder whether the new categorization of Asperger's under the general autism label will make a difference in terms of coverage for evaluations now. We had ours done long before this change.

 

Yes, same here. I hope it doesn't become more difficult for people to get evaluations (supply and demand). Even nine years ago it was difficult for us to find an autism specialist and we jumped through hoops to get insurance coverage. Now living in a different state, looking for a neuropsych and the main hub for testing around here (Childrens' Hospital) is booked a year out. Private neuropsychs who test kids are not thick on the ground, either. :tongue_smilie: It surprises me, because reading this board, it seemed to me it would be easier to arrange testing than it's turning out to be! :tongue_smilie:

[Niffercoo]

We're hoping to get it covered under "seizures" - my son started having them 2 years ago. I really hope insurance will pay for it this time.

 

I need to get my little girl tested next spring, but insurance won't cover it, I'm sure. Our insurance is through a small family-owned company, and there is notation specifically denying any payments related to Pervasive Developmental Disorders (autism, aspergers, PDD-NOS).

[asta]

Be careful what you wish for.

 

I was referred for a full battery of neuropsych testing when my first neurologist (who, by the way, did not specialize in seizures, but specialized in MS, and fancied himself a junior psychologist, having gotten an undergrad degree in it) was trying to diagnose my seizures. Which, BTW, he didn't believe were really occurring. The neuropsych was a friend of his. (I did not know this)

 

According to my then GP, Psychiatrist, and eventual new Neurologist, the neuropsych "test results" were ten pages of absolute b*llsh*t designed to fit the predetermined, preconceived diagnosis of the first neurologist. The first two had spent years with me (I was in psych because the behavioral issues caused by the seizures were misdiagnosed as a psych issue), and the neuro spent enough time with me (every month) to be able to separate the wheat from the chaff.

 

Had I pursued treatment based on what that neuropsych exam said, I would be dead or terribly disabled today. I *strongly* advise people to seek out the advice of doctors and therapists they trust, and not to pin their decision making on specific tests. Not only can manmade tests be terribly, terribly wrong, they can have disastrous, lifelong consequences. Responsible diagnosing comes from looking at a person as a *whole*, over time, not as a "yes or no" based on single test.

 

/rant

 

 

asta

Edited August 6, 2010 by asta

[bairnmama]

Do you have Tricare Prime? If you do, then getting the testing covered should be easy. The first 6 mental health visits are automatically covered and you don't need any preauthorization. I was able to get my dd a psych eval about 2 years ago simply by calling the office and scheduling the appt. NOTHING else was needed! (except my Tricare card of course.) Of course, I don't know if it was a "full" neuropsych eval. The testing took about 4 hours and had several packets of questions for me to fill out, too. HTH

[asta]

Do you have Tricare Prime? If you do, then getting the testing covered should be easy. The first 6 mental health visits are automatically covered and you don't need any preauthorization. I was able to get my dd a psych eval about 2 years ago simply by calling the office and scheduling the appt. NOTHING else was needed! (except my Tricare card of course.) Of course, I don't know if it was a "full" neuropsych eval. The testing took about 4 hours and had several packets of questions for me to fill out, too. HTH

 

That isn't a full exam.

 

A full exam is done over two or three days with written tests, coordination tests, tactile and patterning tests, etc. and an actual, sit down psychological assessment ("tell me about your mother"). And it requires a doozy of a pre-auth. it is so expensive. (eg: it isn't covered under the normal mental health benefit)

 

 

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[lulubelle]

We just received word that our insurance will cover just over half the total cost. We were told to make sure it is for behavioral issues and not educational only. I think this is the best we will get. Even when it is fully a behavioral issue the insurance company will not pay for the specific educational component of the test. But, I was also told to fight for more for my insurance company and see if we can get more coverage. I'm not sure if we will. I'm pretty happy with half the cost being covered by them.

[HeidiD]

my first neurologist (who, by the way, did not specialize in seizures, but specialized in MS

 

Looking for the right specialist within a speciality....

 

Sometimes it feels like looking for a needle in a haystack! :tongue_smilie:

[HeidiD]

Do you have Tricare Prime? If you do, then getting the testing covered should be easy. The first 6 mental health visits are automatically covered and you don't need any preauthorization. I was able to get my dd a psych eval about 2 years ago simply by calling the office and scheduling the appt. NOTHING else was needed! (except my Tricare card of course.) Of course, I don't know if it was a "full" neuropsych eval. The testing took about 4 hours and had several packets of questions for me to fill out, too. HTH

 

We changed to standard. When we lived in CA, we had multiple bad experiences - the Prime network doctors within our area either didn't speak English well enough to communicate with us or had offices with biohazardous waste lying around the examination room, and a woman gave birth on the floor of the military hospital while I was walking around in labor for 8 hours in the parking lot because they didn't have room for us! :lol:. I hope you've had better luck! We were able to get the mental health coverage for our daughter with standard, but we had to get authorization first. Maybe that's the difference.

[HeidiD]

We just received word that our insurance will cover just over half the total cost. We were told to make sure it is for behavioral issues and not educational only. I think this is the best we will get. Even when it is fully a behavioral issue the insurance company will not pay for the specific educational component of the test. But, I was also told to fight for more for my insurance company and see if we can get more coverage. I'm not sure if we will. I'm pretty happy with half the cost being covered by them.

 

 

That sounds like the best path for us to try. I'd be happy with half as well. :)

[Guest]

Our full evaluation took about fifteen hours spread over several days. this included lots of different tests, motor functioning assessment, and hours of discussion: my daughter and the neuropsych, me and the neuropsych both before and after testing. I also got a 28-page, single-spaced report detailing the findings and making specific recommendations for the future.

[Maverick_Mom]

We're hoping to get it covered under "seizures" - my son started having them 2 years ago. I really hope insurance will pay for it this time.

 

I need to get my little girl tested next spring, but insurance won't cover it, I'm sure. Our insurance is through a small family-owned company, and there is notation specifically denying any payments related to Pervasive Developmental Disorders (autism, aspergers, PDD-NOS).

 

My son has a seizure disorder, and we were told by several doctors that that *might* make the insurance company more inclined to cover a neuropsych. Well, sort of. They had a list of doctors who were approved to do a neuropsych, but when we called two of them, they refused to do it. Their reason was this: the insurance company insisted that they complete both the exam and the report in some ridiculously short amount of time -- basically, half the number of hours they felt they needed to do a good job. (I'm not sure why their names were still on the insurance company list.) We've kind of skated along with the very thorough exam ds was given by a school psychologist and a supplemental exam from a psychologist, but ds' neurologist wants him to have a full bona fide neuropsych eval at some point.

 

 

Anyway, I hope your experience is better than ours. :)