How Difficult was it to get insurance coverage for Neuropsychological testing?

[displace]

I'm curious if you had to fight forever to get neuropsychological testing covered by your insurance.  Or maybe it was covered easily.  Or maybe you had to pay out of pocket. 

 

I've looked through our health insurance and it seems like we wouldn't be able to cover testing through them unless we somehow used DS's prematurity to squeeze through the requirements.

 

I'm scared to ask our local hospital how much they charge for it, though before our educational psych testing they did quote $1,200 for "everything" to be tested (it was the NP office) and I wonder if that was for NP testing or not (we were asking about LD testing).

 

If anyone has any experience you'd like to share (or you can PM me if you want), I'd appreciate it.  We're considering testing to eval for dysgraphia.  He had ed. psych testing about 7 months ago and the only thing positive was giftedness.  We afterschool so I'm also going to ask the school to do testing regarding his writing but IDK what they will do or who does the testing, IYKWIM.

[marbel]

I am in the midst of finding that out right now.  My son had testing recently but I am still waiting to hear what if any the insurance will pay.   I will be happy to update when I find out.

[Crimson Wife]

Wouldn't a dysgraphia eval be done by an OT rather than a NP?

 

We would like to have a NP eval done on all 3 kids but our current HMO insurance doesn't cover it and we don't have the budget to pay out-of-pocket for it.

[rmtzc2009]

Our insurance covers full Neuro Psych evals. In our case the Neuro's office called our insurance to get an estimation of benefits & what our OOP cost would be. We did have to prove medical necessity. Our pediatrician just sent a letter explaining why the testing was necessary. My dh and two kids have gone through it & we paid OOP around $300 for each eval.

[MomatHWTK]

We were covered minus the deductable and our ongoing office visits are covered.  I would probably contact the doctor's office, tell them what insurance I had and ask them if coverage was possible. 

[SadieMarie]

Ours was covered too. I think we had to pay two hundred.

[Heathermomster]

My old insurance covered 60% of the NP testing as long as the patient was being assessed for ADHD.  The testing was filed under the mental health portion of the insurance.  All of son's testing has fallen in the $1800 to $2000 range.  You will need to take all prior testing results to the NP for review.

 

Call around and speak with different professionals.  Tell them what you suspect and ask them if they can provide a diagnosis.  Know this...Not all public schools will accept a private diagnosis.  Your DS is very young and I would be very surprised if anyone would diagnose him until he is older.

 

If there is a dyslexia school nearby, call them directly.  Speak with the headmaster and seek out recommendations for testers from them.    

[lizlatorre]

My son's neuropsych eval was covered, but it took a couple of tries. The first time, the dr. that made the referral used my son's language diagnosis, and it was denied. So the dr. allowed the therapist to rebill using my son's other diagnosis, encephalopathy NOS, which was considered medical, and it was approved.

[FairProspects]

The insurance company covered ZERO for us for either child. We paid for both evals entirely out of pocket and will probably have to do it again in the late middle school or early high school years. We live in a state that has NO required insurance coverage for any neurodevelopmental conditions so if they don't have to cover it, they don't. The only way we could have gotten even 50% coverage was if dc had a TBI or a stroke or other medical diagnosis. No ADHD, ASD, or LD coding would result in any coverage.

[prairiewindmomma]

We couldn't get it covered. We have fought with three kids. I couldn't even get it covered for the kid with a TBI. We have switched insurance companies and we are about to take up the fight again.

 

My advice (having gotten other things, like experimental chemo, etc. covered):

1. get specific codes to check

2. get any denial letters in writing

3. ask how to appeal

4. send documentation in with the appeal

5. if your insurance is through a company that self-pays but hires someone else to administer, appeal internally within the company through HR

[Timberly]

.

[PeterPan]

Timberly, what a great story!!!!!   :hurray:   :hurray:  :hurray:

[displace]

Thank you greatly to everyone for all your personal stories!  It's truly helpful to gain some insight.  I will re-consult my health insurance as it is covered but I'm not sure how, and call them to ask.  Our public school has already accepted our ed psych paperwork so I'm hopeful they would take a NP, but that's a good question to ask. 

 

And now I have a good game plan too.  Depending on what's required I could ask pediatrician, developmental peds, call the NP office, call the insurance, talk to the school, ask a dyslexia school (I'm not even sure if there's one around?), beware of educational vs medical diagnoses, etc.  It's good to be informed, and I think you've all saved me a lot of research already. 

[Tap]

We have United Health Care and Washington State Medicaid (dd7 is my great-niece and a ward of the state).

 

We went through a local teaching hospital, OHSU and while it took a year to get her into the doctor there, they got the approval within a week of submitting it.  

 

United Health Care paid for all but my regular copay of $15 which medicaid picked up.

 

It was harder to get them to approve us to be seen, than the insurance company.  They have a year long wait, so they make sure the tests go to the kids who really need it.  DD had to have a letter from her PCP, Psychiatrist and Behavior Therapist which accompanied actual chart notes pointing out her specific issues.  She was either static or loosing ground academically in public school so we also included her testing scores. She already had a diagnosis of PDD-NOS so that may have helped with the approval.

 

 

 

[Tiramisu]

We have Blue Cross Blue Shield. NP testing is covered but it depends on why, or perhaps what the dx turns out to be.

 

I called and confirmed our benefits. The NP called and confirmed. Then the NP, who was the only one who could apply for an prior authorization, didn't.

 

We went through two appeals procedures, submitted about 200 pages of medical records, got letters of medical necessity from several specialists, had my pediatrician do a conference call with the appeal panel. And we were not successful. It was very upsetting.

 

The insurance company told us not to pay the NP because it was her mistake, but we paid anyway because I thought she should be paid for the work she did. I did so grumbling, but I had to do it for my sanity to just have it over with. Meanwhile, I made a formal complaint with the insurance company after she received an informal correction from them and still pressured me for payment.

 

 

[DawnM]

We had to pay OOP and then get reimbursed.

 

Our insurance would cover none of the academic end and only 80% of the neurological.  We were ok with that because we wanted to go to the highly recommended place rather than within network and worry that the testing was sub-par.

 

We had our son tested for LDs and Asperger's.  Total cost for testing was $1,650.  Insurance paid about $850.

[Storygirl]

Our insurance will not pay for testing they consider educational, specifically for ADHD or dyslexia. We were preapproved for 8 hours of testing, because we had some concerns about spectrum-ish behavior. However, now the insurance has denied the claim, saying the services rendered do not match what was preapproved. And there is a large error in the actual amount billed. So we are in the midst of making a lot of phone calls to clear it all up.

 

So, make sure you know what your insurance will cover; make sure that the neuropsych applies for preapproval; and be prepared for dealing with a hassle if there are problems despite all of that.

[Tokyomarie]

We used a neuropsych who doesn't do any insurance billing or approvals at all. Like someone else said, it was important to us to use the person we felt was right for our situation, not just anyone because they would bill our insurance. This was 4 years ago, but I was told over the phone that we had coverage for a neuropsych eval as long as the purpose was not solely academic. I went ahead on that basis, knowing we would have to pay out of pocket and submit for reimbursement. In the end, our claim was denied the first time, and I had to take it up the chain. When I made it clear that I was concerned that our high school aged child may not be able to function in the world as an adult if we didn't figure out how to help him, the insurance company agreed to pay.

 

If I were doing it differently today, I would make sure to note in a log the name of the person I spoke with and the date and time of the call for each call or other communication with the insurance company about the potential or actual claim.