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Insurance? How to get diagnosis?


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I just got off the phone with insurance. They said that any behavioral diagnosis' are not covered... no add, adhd... no learning disabilities... that is simply not covered by the insurance. Am I asking the wrong questions? I wanted to know what would be covered for a pediatric psychologist or specialist to help diagnose... the school district wont do any further diagnosis because it hasn't been 3 years since his last "testing". I want to help my son... I need help and just keep thinking that if I can pinpoint the problems, I can learn to deal with them...


Is this true? Will it help any to have a diagnosis? So far, I just know he has dyslexia and adhd. I think there is more going on... I think there is sensory integration disorder... I KNOW he doesn't remember what he is taught in certain subjects... it looks like he has dysgraphia, too...


How do I know how to help him if I don't have a professional to turn to?


Thanks... I am feeling frustrated and overwhelmed... And here's to you with much more on your plate than I have, I am in awe...



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I have never heard of the three yr. rule. Sometimes I have testing done annually to see progress. They just might be yanking your chain.


We had to sue the school to get the neuropsych eval and proper treatment done. It only went to mediation and it was worth the time and trouble.


Wrightslaw.com has a lot of info. to back up your rights under IDEA. If the teacher says no ask for IEP, than go to head and keep asking til you get the answer you want. All schools has a system of barricades, and it is all about breaking down the walls for your child.


In this sit. you have to take the bull by the horns. You have rights , use them.

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In NY school districts do a full workup trienially(sp?) every 3 years. As for insurance my ds has some coverage, under mental health. Anything to do with ASD and I believe ADHD is considered mental health under the dx codes. If you have a mental health portion to your insurance(usually a different company) you could start there. That said, I don't know of any insurance company that covers things like speech and OT unless it is a stroke victim. Sorry for your troubles. I know the feeling.

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I am working backwards on this one. First I called the Occ Ther. office where we would ultimately go, asked about what is in an eval and if our insurance would cover some of it. They were very helpful. I found out from them what referrals would be acceptable to them and the insurance group also.

Was there any observation on the last testing that you could grab onto as the basis for further eval? Any comments from the test administrator that could be construed as back-up for your position regarding fine-motor control or attention? Then perhaps you could ask that administrator to write a referral based on those observations. As in, "Certain behaviours warrant inspection or evaluation as they may stem from underlying atypical neurological conditions"? (not sure of the wording there...)

good luck - jill

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