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Our insurance will pay for ANY testing that is ordered for DS. I want to have him tested to get an idea of where he is and because I know he will have to enter the public school system at some point to take advantage of the dual enrollment options in our area that are not available to homeschoolers. My issue is that if I don't have a planned conversation laid out to have with the doctor I don't articulate what we need or why we need it very well. Can you experienced parents help me with this? Also should I be speaking to the pediatrician or to someone else? If someone else I will have to have this discussion twice so that I can get a referral from the ped.

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It's going to depend on your insurance. Our old insurance would cover testing only if there was a medical referral and a possible medical DX. My DD 7 was tested at 2 1/2 because there were enough problematic symptoms to support our pediatrician writing the referral, even though she said, even as she wrote it, that she was reasonably sure DD was "too smart for her own good and not yet able to manage it well"-so she was tested for a whole laundry list of possible conditions, with ASD being the big one-and came out with a DX of GT.

 

Our current insurance allows going directly to a specialist, but is MUCH more limited in what it will cover-and they're not good at telling you definitively whether X, Y, or Z will be covered. I'm pretty sure the testing we got done previously would be considered educational, not medical, and not be covered at all.

 

Regardless, I'd just lay it out to your pediatrician and let him/her find the appropriate billing codes.

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