Private eval cost

[LifeLovePassion]

We are looking at doing a 3 appointment private eval workup. 1st meeting is parents only to interview and go over filled out surveys and decide on tests . 2nd is testing and 3rd is results meeting. Can anyone give me a ballpark of what their cost was? The clinic gave me some billing codes, but my insurance company said there was still variables as to actual cost, so I got no where. PM me if you like.

[nature girl]

Insurance should pay for your first and third meetings, so you should only have to handle the copay.

 

Our actual eval was close to $4,000. We were responsible for around $1,500 of that.

[Heathermomster]

We had three np evals, and they all cost about $1800.  I guess it depends upon where you live.

[TrixieB]

My kid had the same evaluation setup as you describe.  Beforehand, I verified the CPT (services) codes with our insurance to be sure they were covered.  One of them is an hourly code so that is one variable that could depend on the individual kid.  The clinic billed about $4000 and it's still out at insurance.  

 

The actual cost for any of us will depend on a number of things:

 

your insurance's negotiated rate for each CPT code

number of hours billed

whether your insurance is copay or co-insurance

if your child has already met their yearly deductible

what your co-insurance percentage is

whether the provider is in-network or out-of-network

exactly what testing was done

does your insurance cover all the billed services (for example, educational testing may not be a covered service)

 

[Crimson Wife]

What kind of provider are you seeing? Developmental pediatrician, neuropsychologist, educational psychologist, someone else?

 

The neuropsych charged us $3500 in 2015 and our insurance unfortunately didn't cover any of it.

 

The developmental pediatrician charged IIRC $1800 in 2011 and insurance picked up 90% of the cost.

 

The last full speech & language eval my DD had in January cost $1700 and insurance picked up 90% of the cost.

Edited June 19, 2016 by Crimson Wife

[PeterPan]

You CANNOT go by what other people paid, because it depends on whether your psych is hospital or independent and then your insurance coverage.  The smartest thing to do is get it pre-approved.  When we looked into a psych associated with a hospital, they required it to go through the insurance ahead, and I got a letter saying what I would be billed at per hour if I used them and what the insurance would cover and what it would not. You can ask the psych what price they bill at per hour.  Will your psych file the insurance?  If it's a hospital, around here they bill at dramatically more than the private/independent rate, but they'll file the paperwork.  Independent/private psychs around here won't file your insurance, but they'll tell you what they bill at.  So for private around here, you pay upfront and wait for your insurance to reimburse you.

 

They ought to be able to tell you basic things like co-pays, what the per hour billing will reduce to, that kind of thing.  That would at least get you ballpark.  A full hospital neuropsych eval can be close to $10K around here, and privately it will be under $2500.

 

I would not keep an intake appointment with a psych you can't afford, because there will be others you can.  

Edited June 19, 2016 by OhElizabeth

[Lecka]

Can you follow up at the clinic, and maybe ask more directly?

 

They can't say exactly what your insurance will do, but maybe they can say what has been covered by that insurance in the past.

 

Can you ask again at the insurance?

 

Can you ask the insurance if they need different/more information from the clinic?

 

Would it help if you got a letter from your regular doctor?

[rmtzc2009]

You should be able to get a good idea of the cost involved before the appointment. I would confirm what your Psych coverage is and that the testing is covered under your insurance plan. Also, that your doctor is in network.

 

Our insurance was billed around $4000 and our out of pocket cost was $225.00.

Edited June 20, 2016 by Momof3IL

[MistyMountain]

In my area it was close to $5000 which is why I could not get them done for my kids.

Edited June 20, 2016 by MistyMountain

[FairProspects]

In my area it was close to $5000 which I why I could not get them done for my kids.

 

This is the cost for us too and our insurance will not cover neurodevelopmental codes at all. They only cover neuropscyhological services for cancer or TBI. We pick up 100% of the cost personally.

[displace]

Most psychs and Neuropsych here charge ~$100/hr. I think I'm in a cheap area. Testing time is about 8 hrs.

Edited June 20, 2016 by displace

[TrixieB]

Most psychs and Neuropsych here charge ~$100/hr. I think I'm in a cheap area. Testing time is about 8 hrs.

 

Your area costs less than ours.  Here it's almost double your hourly.  And they charge for testing, evaluation, interpretation, write-up, etc., so about 18 hours.

[hornblower]

One tip we were given is that with some providers, if both parents and the child attend one or more of the sessions (usually the intake & the last)  they can split the bill 3 ways. So the child got billed about 2/3 & the parents 1/3 each (for the consultation & report giving & advice on how to interpret the scores & what remediation etc etc.) If your plan has per person limits, this lets you spread the costs so you don't max out the child's...
 

[FairProspects]

Most psychs and Neuropsych here charge ~$100/hr. I think I'm in a cheap area. Testing time is about 8 hrs.

 

Yes, that is definitely a low cost area. Most parent coaches and therapists cost more than that here. Anyone with a JD or Phd is $250+ per hour.

Edited June 20, 2016 by FairProspects

[Upptacka]

We just had testing done with a neuropsych. First visit (interview with parents) was billed $150, and then the actual testing with DD (visit two.....took about 3 hours) was billed out $950. The third visit was with me to discuss results, recommendations, etc. I have not seen the bill yet, but I am guessing it will be like the first visit ($150).

[ekorda]

Are you talking about educational or behavior eval?  (Im assuming educational based on the board...but thought i'd ask anyway).  It really depends on your insurance....our insurance paid for my daughters behavior eval (suspected Inattentive ADD and was diagnosed after testing)...but they didnt pay for educational testing.  We are in the DC area and had to pay $3000 for a neuropsychologist to do the testing (This included the testing and post-test meeting to discuss results).  It is not cheap but I am SO thankful that we got it done because now we can have a plan.  My daughter struggled for 4 years and we were told so many different things...all the while my "mommy gut" told me it was Dyslexia....guess what, I was RIGHT!  *ugh*  Best of luck - what exactly are you testing for?