Did your insurance cover an NP eval?

[summerreading]

I am trying to see if my son's insurance covers an evaluation but they wanted CPT codes. Have you had success getting insurance to pay for your evals?

[merry gardens]

Our insurance covers very little until we've met our incredibly large deductible. If we've already paid about $10,000 for the calendar year, the cost of a neuro-psych would be covered. 

 

After asking local friends and professionals for years for recommendations for a good neuro-psych I finally found one that I think would be helpful. If we come close to our deductible through other things, we'll definitely see that neuro-psych and it will be covered, but until we've paid our deductible, it's all out of pocket.   

[Heathermomster]

My insurance covers a majority of the costs if ADHD is diagnosed.

[summerreading]

My insurance covers a majority of the costs if ADHD is diagnosed.

 

so you have to get your diagnoses first and then you can apply for reimbursement?

[Heathermomster]

so you have to get your diagnoses first and then you can apply for reimbursement?

I paid for the intake interview. Once diagnosis was provided, the NP filed with insurance. She waited to charge us until she received feedback from BC/BS. Insurance reimburses us by direct deposit. My only out of pocket expense was the intake interview which was maybe $250. It is terrible that I can't remember our exact costs. My DD has health issues that cost quite a bit, so NP testing was water under the bridge.

 

For testing 3.5 years ago, the NP did not accept insurance, so I paid a deposit and the remainder during the first day of testing.

[FairProspects]

I am trying to see if my son's insurance covers an evaluation but they wanted CPT codes. Have you had success getting insurance to pay for your evals?

 

Not a cent unless it was for TBI, stroke, or cancer. Insurance would pay nothing at all for ADHD, ASD, SPD, or any other learning disability. We paid every penny ourselves both times.

[displace]

Our insurance covers for certain diagnoses.  I have found documents on the internet put out by my insurance company on specific treatments and applicable codes and diagnoses.  For instance, vision therapy is covered if convergence insufficiency (for example) is a diagnosis, and the CPT codes are listed, as well as ICD codes.

 

Also, I've called the insurance help line/member benefits and gotten similar reports.  They're usually helpful and used to answering questions like that.  If the NP can provide what testing is usually coded as, you can ask insurance if it's covered.  Or diagnosis code required. 

[PeterPan]

Wouldn't matter if the insurance did, because the private psychs in our area won't take it.  If you do insurance, around here I think you have to go through the hospital system.  Ironically, the hospital bills at $350 an hour, where private psychs bill at $220.  

[Tap]

Yes, our private insurance covered the majority and dd8's state insurance picked up the copay.

[Princess Ariel]

Ours will pay for the psychological testing but not academic testing (reading, writing, math).  This is a change in the past few years.  When my kids had their first evals several years ago, it was covered in full but since that time has changed.