Cost of evaluations

[laundrycrisis]

Our insurance, through DH's employer, specifically excludes all testing, evaluations and therapies that turn out to have anything to do with mental (not physical) developmental delays. The company self-insures...an insurance company administers the plan, but the employer completely funds it. Legally, there is nothing to stop them from excluding everything to do with mental/cognitive developmental delays from coverage. It also is not included in the mental health plan. If a diagnosis code indicates a developmental delay, they specifically exclude it. So...

 

This means that all of DS1's vision therapy over the last two years was paid for out of pocket. None of it could even count toward any kind of maximum. We spent a lot of money on this.

 

DS2 is in need of speech therapy. This will also be all out of pocket. I found a therapist who is willing to train me to do the therapy with him and see him less often (monthly instead of weekly) to reduce our cost. I tried to get him into a low-cost clinic, but the deadline to even get on the waiting list was two days away, and the waiting list is almost a year long.

 

Vision therapy has helped DS1 so much, but I still see a lot of problems for him. :( The sequential memory problem picked up in the vision therapy testing is obviously still very much there. I suspect he would still be considered dyslexic, and definitely dysgraphic. Writing is just so hard and frustrating for him and he has great difficulty remembering any sort of string of letters, words, or numbers. I also suspect ADD and working memory issues as well. His vision therapist has an OT background and she has suggested that he has very low upper body muscle tone and would be a candidate for OT. I also observe him engaging in some physical behaviors he uses to distract himself that seem compulsive. But I don't have a way to get any of this tested or evaluated without paying for it out of pocket. I understand that can go into the $2-4k range.

 

DS2 has some mood swing and pretty extreme behavior issues. This is not a lack of discipline and structure situation, and it is not caused by "the isolation of homeschooling". We are not isolated, or unstructured, and discipline is a huge part of what I do ! He has something going on. He is immature for his age, has pretty severe and sudden mood swings and almost no self-control. I can hope that with my best efforts at behavior modification and filling his bucket, in two years he may have matured through a lot of this, but in the meantime, it is affecting his ability to participate in things. It is really hard for anyone to have him as a student for any sort of class or activity. He also has trouble with social situations but only when his mood has swung the wrong way. There does not seem to be any pattern or trigger for the mood swings so I can't plan around them. It puts a lot of stress on DS1, me, and DH also. Again, I don't think I have any way to get this evaluated and get any coverage for it, unless I find someone who can claim a different diagnosis that won't flag the evaluation or any therapies as being related to a developmental delay (that would include any and all ASD issues). He saw a play therapist last year who called it PTSD and it was covered under the mental plan..but unfortunately I didn't get any answers from her and the therapy didn't make much difference in the big picture. When I discontinued, her recommendation was to have a full evaluation in a year or two if he is still having issues.

 

I don't want to go to the school district for any of this because I think initiating contact with them could open a huge can of worms for us, and that we probably wouldn't get much help from them anyway. Other than hoping that at some point DH changes jobs to an employer that does not specifically exclude for these things, I don't know how to get professional eyes on any of these issues without paying out of pocket for everything, which I think would be a huge cost. It's really frustrating.

Edited January 24, 2012 by Laundrycrisis2

[Tokyomarie]

Do you have a university within a reasonable distance that trains students in educational and/or neuropsychological assessment? These students work under the direction of faculty. The cost of assessments is usually much less than when they are done in a private office or hospital clinic. It is worth checking out if you have any major universities with graduate psychology programs.

[FairProspects]

:grouphug: No answers, but I hear you. Our insurance is the exact same way and it is incredibly frustrating.

[itsheresomewhere]

For the OT eval- call around OT providers. I paid out of pocket for just an OT eval and it was 300. Not too bad and they let me break it up. They also offer cash discounts for regular visits. Also, if you have a university nearby that you don't mind if they use the grad students to test the price drops. Private evals here are 2000-4000 but a grad student doing it under the professors eyes is 500-1000.

[PeterPan]

Our OT eval wasn't bad, and definitely that's one you can do as a once a month thing. I think it's MUCH better to put your money into in-home things (single line swing, that sort of thing) and let the OT teach you what to do and why.

 

Sounds like you need a neuropsych eval to get the diagnoses finalized. That's the expensive one. :(

 

Do you realize you can work on his working memory now? The Linguisystems EF workbook is around $40 (I forget exactly) and has lots and lots of categories of things for you to work on.

 

It's a shame your employer doesn't do HSAs (health savings accounts).

[Laurie4b]

Our insurance, through DH's employer, specifically excludes all testing, evaluations and therapies that turn out to have anything to do with mental (not physical) developmental delays. The company self-insures...an insurance company administers the plan, but the employer completely funds it. Legally, there is nothing to stop them from excluding everything to do with mental/cognitive developmental delays from coverage. It also is not included in the mental health plan. If a diagnosis code indicates a developmental delay, they specifically exclude it. So...

 

This means that all of DS1's vision therapy over the last two years was paid for out of pocket. None of it could even count toward any kind of maximum. We spent a lot of money on this.

 

DS2 is in need of speech therapy. This will also be all out of pocket. I found a therapist who is willing to train me to do the therapy with him and see him less often (monthly instead of weekly) to reduce our cost. I tried to get him into a low-cost clinic, but the deadline to even get on the waiting list was two days away, and the waiting list is almost a year long.

 

Vision therapy has helped DS1 so much, but I still see a lot of problems for him. :( The sequential memory problem picked up in the vision therapy testing is obviously still very much there. I suspect he would still be considered dyslexic, and definitely dysgraphic. Writing is just so hard and frustrating for him and he has great difficulty remembering any sort of string of letters, words, or numbers. I also suspect ADD and working memory issues as well. His vision therapist has an OT background and she has suggested that he has very low upper body muscle tone and would be a candidate for OT. I also observe him engaging in some physical behaviors he uses to distract himself that seem compulsive. But I don't have a way to get any of this tested or evaluated without paying for it out of pocket. I understand that can go into the $2-4k range.

 

DS2 has some mood swing and pretty extreme behavior issues. This is not a lack of discipline and structure situation, and it is not caused by "the isolation of homeschooling". We are not isolated, or unstructured, and discipline is a huge part of what I do ! He has something going on. He is immature for his age, has pretty severe and sudden mood swings and almost no self-control. I can hope that with my best efforts at behavior modification and filling his bucket, in two years he may have matured through a lot of this, but in the meantime, it is affecting his ability to participate in things. It is really hard for anyone to have him as a student for any sort of class or activity. He also has trouble with social situations but only when his mood has swung the wrong way. There does not seem to be any pattern or trigger for the mood swings so I can't plan around them. It puts a lot of stress on DS1, me, and DH also. Again, I don't think I have any way to get this evaluated and get any coverage for it, unless I find someone who can claim a different diagnosis that won't flag the evaluation or any therapies as being related to a developmental delay (that would include any and all ASD issues). He saw a play therapist last year who called it PTSD and it was covered under the mental plan..but unfortunately I didn't get any answers from her and the therapy didn't make much difference in the big picture. When I discontinued, her recommendation was to have a full evaluation in a year or two if he is still having issues.

 

I don't want to go to the school district for any of this because I think initiating contact with them could open a huge can of worms for us, and that we probably wouldn't get much help from them anyway. Other than hoping that at some point DH changes jobs to an employer that does not specifically exclude for these things, I don't know how to get professional eyes on any of these issues without paying out of pocket for everything, which I think would be a huge cost. It's really frustrating.

 

Do you have specific reason in your locale to suspect that contact with the public schools would open up a can of worms? I ask because a lot of homeschoolers have that impression and it is usuallly NOT true. What happens in some town in another state is not applicable to you.

 

The public schools in many areas will do an evaluation for free for learning issues (not the mood issues). This is not a complete evaluation as you would get with a neuropsych, but it gets you some of the expensive components for free. (For instance, administering a WISC (an IQ test) is usually an expensive part of the neuropsych eval, but most schools administer it.)) The schools are also likely to do an individual achievement test such as the Woodcock Johnson. Then you can take those component parts to a neuropsych and it will reduce your evaluation costs. Not all neuropsychs charge $$$. We have one in our area who uses a church office for free, so she doesn't have overhead charges to pass on and she doesn't. Large universities also test. They will have long waiting lists, though.

 

An OT eval is probably going to run a couple hundred dollars, not thousands.

 

I would talk with your pediatrician about the mood issues. They can likely be evaluated by a developmental pediatrician, which would be a medical eval and should be covered by insurance.

[funnygirl]

Just wanted to vent along with you about insurance issues. Would you believe that insurance doesn't cover hearing aids for a hearing impaired child?? UGH.