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Neuropsych Exam Not Covered


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Hi all,

My dd is 16 and has always been homeschooled. We've always known that she had difficulties processing and retaining information, but we postponed testing as we were accommodating her at home,  and I knew that I would need current neuro psych results for standardized testing and supports in college.  

She took the PSAT in 9th and the school district allowed her to have extra time because she didn't need formal documentation at that age. Now that she's 16, we need to submit a case to the College Board for testing accommodations. She took AP exams both in 9th and 10th grade, and as we predicted, struggled without the extra time for testing.  

I called my insurance company and was told that a neuro psych exam is only covered if it's medically necessary. What makes it medically necessary and covered by insurance? 

I had emailed the local high school regarding having her tested with them and didn't get an answer. Are they legally required to test her? 

Thanks so much!

 

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"Medically necessary" usually means concerns that will lead to medical diagnoses other than purely learning-related issues -- ADHD, Autism spectrum, mental illness, etc.    So for us that meant that my middle DS's neuropsych for behavior concerns that could have been ADHD or autism spectrum related was easily considered "medically necessary" but we could not get insurance coverage for an exam for my youngest DS who primarily needed an evaluation for dyslexia/dysgraphia.    Our insurance company had a form (to be filled out by the  neuropsychological testing professional) and a document with a pretty clear list of guidelines as to what they considered "medically necessary" or not.   So, you may be able to track down similar detailed information for your insurance company....maybe from a more helpful customer service rep or maybe from googling. 

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Thanks to all of you!  Yes, I think her pediatrician would recommend it. We recently changed doctors, but I think she'd refer her. Is there someone recommended on the East Coast?  I don't mind driving for a qualified neuro psych. I'd hate to go through all of this to end up with someone who dislikes homeschoolers or isn't open to hearing what we've observed/gone through.

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Your local public school district is required to do testing if you request it in writing. However, it has been reported by lots of people that schools will not tell parents that fact. An email is not necessarily considered “in writing”. If you do decide to go through the public school, it would not be unexpected for them to take as long as absolutely possible.  Like it is not likely to get completed  early enough this school year to apply for testing accommodations for this year.

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3 minutes ago, cuckoomamma said:

I don't mind driving for a qualified neuro psych.

Doesn't have to be a neuropsych. They're typically the ones running enough hours, but sometimes also clinical psychs, ed psychs, etc. are doing good evals. Your best bet is to call and ask each prospective psych upfront how many hours, what they typically run for whatever you suspect, etc.

4 minutes ago, cuckoomamma said:

I'd hate to go through all of this to end up with someone who dislikes homeschoolers or isn't open to hearing what we've observed/gone through.

This is also what you'll find out by talking with them. They'll typically listen for a minute and then attempt to show off what they know or could do. You'll know. In my small experience, if they're a donkey's butt on the phone, they'll be one in the office too.

Not to hurt your feelings too much, but they may not care about hearing about what you've observed. They will a bit, but write it up. All this stuff is standardized. They're going to give you questionaires out the wazoo and you'll fill them out. Your anecdotes can provide evidence to say move a support level, but it doesn't drive the diagnoses. That will all be numbers, what the testing shows.

3 hours ago, cuckoomamma said:

We've always known that she had difficulties processing and retaining information,

I would be careful assuming a neuropsych eval will answer this. It might be incompletely. You could also benefit from audiology, SLP, or OT evals.

3 hours ago, cuckoomamma said:

I had emailed the local high school regarding having her tested with them and didn't get an answer. Are they legally required to test her? 

If you are in the US, it is a *federal right* under IDEA to get evals. The ps is legally required to "identify students with disabilities affecting their ability to access their education." This means you may need to demonstrate that her disabilities are affecting her ability to access her education. If her grades are strong, the school could try to deny you based on that. You can push back, but you want to go in prepared.

What the ps is NOT required to do is write an IEP. That's an additional step and that is decided by state law. Some states require the ps to write the IEP, some do not, and some merely allow it. 

I will observe that going through the ps gives you the opportunity to get multifactored evals. I had my dd evaled through the ps at 16 for her last time before college and it was a mixed bag. They did all the evals in theory (OT, psych, etc.) but they blew off a lot saying try yoga, we'd offer you a 504, please come enroll (she had great ACT scores), etc.

So you're going to *learn more* if you can make the evals happen privately. At that point the question is only *which evals*. Neuropsychs like to bill themselves as a one stop shop but they aren't. You might get more actionable information by bringing in some other professionals. Even the eval process can be very instructive if the OT, audiologist, etc. does it over a number of sessions/hours and really spends time to talk with the teen, help them understand their bodies, etc. It's not so much about doing tons of therapy as it is this learning process. It puts the teen in a better position to self advocate, which is the real thing you'll need for college.

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22 minutes ago, City Mouse said:

Your local public school district is required to do testing if you request it in writing.

This is not technically correct. Op can get the NOLO book on the IEP process if she wants to get very technical. The school is allowed to say that you do not have EVIDENCE to cause them to suspect a disability affecting the dc's ability to access their education. Some districts will pull stunts, but it's because legally they have the right to say no to evals if you do not bring evidence. They are not compelled to eval EVERYONE who asks. They will have an initial meeting (per your state's IEP timeline, which you can find on your dept of ed) and it will be decided then. 

22 minutes ago, City Mouse said:

An email is not necessarily considered “in writing”.

Although I would not do it that way, I'm pretty sure legally an email *is* a request. The problem is they'll say you didn't really request it. You actually have to say the words. You can't sorta back door and ask "if" they're done and "could" they and all that mess. You actually have to say "I SUSPECT MY DC HAS A DISABILITY AFFECTING THEIR ABILITY TO ACCESS THEIR EDUCATION AND AM REQUESTING THE SCHOOL CONVENE A TEAM TO DETERMINE WHETHER EVALS ARE WARRANTED." and thakn you and sign and all that jazz.

But what happens is Mom writes some kind of polite mumbo jumbo and they're busy with the start of school and it gets shuffled. So I agree it's *better* to write the above (hand, typed, doesn't matter), sign, date, PHOTOCOPY and hand it to the person at the front desk. Then it's their problem. If you're *polite* what you'll do is call, ask to talk with the principal of the school your dc would attend were they enrolled, and discuss it with them. That will smooth the way and get you off to a nice start. But none of that is "the request." The request is when you say those lines specifically, sign, date, boom. It can be email, it can be written, but it has to be that clear or they'll just say you were sorta inquiring. 

22 minutes ago, City Mouse said:

Like it is not likely to get completed  early enough this school year to apply for testing accommodations for this year.

Just varies. I can tell you I consistently hear that October is an easy time to get evals through the ps. At that point they've finished up their kids that were hanging over from summer and they have some breathing room. But nothing happens fast in the ps. You make the written request, wait 30 days for a meeting, then if they agree to eval it's another 60 days they have to get that done. 

So if you make a formal written request now, you'll be evaling by October and have results by November/December. A private psych might have a wait of 3-6 months or more. I've been hearing weird things with covid about it being extra hard to get evals. 

I'll say this again, but you may want more than the psych. Psych is fine, but SLP, OT, audiology may give you highly actionable information, depending on what you've got going on. And they're specialties you can get into much faster.

Edited by PeterPan
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27 minutes ago, cuckoomamma said:

I think she'd refer her.

So not to burst your bubble, but you may still have trouble. Hospital neuropsychs are more $$$ (like 3X more) but they will be very insurance-y. Private neuropsychs around here typically (from the ones I've used) don't want to fiddle with your insurance. So you have your insurance and preapproval, but it varies with private vs. hospital.

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I'm just going to second what has been said -- Use the specific words "we suspect a disability and request evaluations under Child Find in the IDEA." Google those terms yourself, so that you know what you are asking for. Even better, get the NOLO book and read what your state department of education says online about testing for disabilities. The truth is that the school systems are not always up to speed on how to handle requests from homeschoolers, so you need to know the process for yourself. Don't expect the school to make things easy or clear.

If you get evaluations from the school and don't get enough testing to tease things out, you can take those results to a private psychologist, who can use the information already provided by the school and add to it with their own testing. This can make private testing cheaper.

But it does take time. The school has 30 days to respond to your written request. And, yes, technically, they can say that they do not suspect a disability and won't test. If you have any kind of documentation of her troubles, you could include it with your request as some evidence that there are issues. You can say that you provide accommodations at home, and that she still has difficulties in areas X, Y, and Z.

When we did this, I prepared a list of the accommodations that I had been providing for my kids and brought it to that initial meeting. There should be a meeting within 30 days of your letter (30 calendar days, not school days) to decide whether they will agree to evaluate or not.

Then after they agree to evaluate, they have 60 days to run their testing and present you with the report that says whether they found any issues or not. So it takes some time. I don't know when you think you will need the documentation, but plan on it taking awhile.

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We've seen three different neuropsychs for three kids. Plus two different psychologists (second round of testing for two of the kids)!

The first NP told us that insurance would cover testing for our older son, because we had questions about autism. But that insurance would not cover their services for our daughter's suspected dyslexia. Because testing for learning disabilities can be done by the schools, insurance can consider it "academic" not "medical" and refuse to cover it. That NP suggested that we have the school test her first, then bring the reports to them, and they could complete what they needed to do for her at a lesser charge (because they would not rerun the tests that the school did).

We ended up paying out of pocket for NP testing for that daughter, instead of using the schools at that time.

Then we had our second son tested by a NP, because he was having problems that we thought might be auditory processing, processing speed, or receptive language. First, we had his hearing tested by audiologists. They then referred us to an ENT. The ENT said hearing and auditory issues were not the problem and referred us to the neuropsych at the same children's hospital. Because it was a referral from a physician, insurance covered the testing (no one told us that this is why it was covered, but I assume).

This son ended up not getting any of the diagnoses that I suspected (he did get an anxiety diagnosis, which I did not suspect), so testing does not always turn out the way that you might think. We had some surprise information come out of the testing of my first son, as well.

All this to say that sometimes insurance will cover, and sometimes it will not. When you call and ask about appointments, you can ask the office staff about insurance coverage, because it can also vary from practice to practice. Some private psychs may not take insurance at all, and some will.

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Oh, I have also had two of my kids subsequently tested by the schools, when we stopped homeschooling and enrolled them.

Since I already had their NP testing done, I had PLENTY of documentation of their disabilities, but the special education case manager that we had to deal with had her own agenda and opinions, and she made it very difficult to get the school testing process started.

Sometimes the personnel of your public school can be really helpful and accommodating. Sometimes they seem to enjoy making the process hard for parents. This is unfortunate, but true. Don't expect the school to be against you, but also don't be surprised if they make it hard. I was caught off guard by the resistance we met up with, so I just like to warn people a little.

Hopefully it will all go smoothly with your school district. Oh, depending on where you are, this may be the first week of school, so it's not a surprise that you didn't get a response yet.

BUT if you just INQUIRED about testing, they can blow you off. You have to REQUEST it under the law.

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22 hours ago, cuckoomamma said:

We've always known that she had difficulties processing and retaining information

As @PeterPan noted, you might need more than a neuropsych or ed psych. If you want to know more about auditory processing or language issues, several of us can speak to those things. 

22 hours ago, cuckoomamma said:

She took the PSAT in 9th and the school district allowed her to have extra time because she didn't need formal documentation at that age. Now that she's 16, we need to submit a case to the College Board for testing accommodations. She took AP exams both in 9th and 10th grade, and as we predicted, struggled without the extra time for testing.  

Are the scores a little different or a great deal different without the time accommodation? I would think that having a track record with the SAME test vs. different tests could show meaningful data. They might not think that comparing PSAT to AP exams is helpful.

Extra time is not the only accommodation. If you think she'd benefit from taking it in a small group environment/quiet room, you want to ask for that as well. My DS found a quiet room/small group incredibly beneficial. He had done a bit of test prep at home, but it wasn't always quiet in the house. He could tell a BIG difference with a proctored quiet room.

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