Need quick advice on getting this authorization nailed!

Discussion in 'General Parenting' started by BestICan, May 22, 2008.

  1. BestICan

    BestICan This community rocks.

    Hi, after months of fighting my insurance company, we got an authorization for a consult with a neuropsychologist, and even got a last-minute appointment for tomorrow (Friday) afternoon!

    As I understand it, we need to sufficiently convince this neuropsychologist that difficult child needs testing. Then he needs to request authorization from our miserable HMO for the actual testing. Miserable HMO then needs to approve it before we can move forward.

    I am not sure how this works, but I'm worried that difficult child isn't going to be viewed as "severe" enough to get authorization for testing. After all this fighting, I need to make this appointment count! My main goal at this point is a 504 to protect him from over-the-top consequences should his impulsive behaviors get him in trouble next year at his new school. His academics are excellent, by the way, so I'm guessing an IEP isn't in our future.

    Previously his neurologist refused to give us a letter that would support a 504. (Reason: His seizures are controlled. There's a correlation between his behaviors and his underlying seizure disorder, but not a known causal relationship.) I want that 504! And I bet it would be fairly easy to get an ADHD diagnosis for him from a pediatrician, but I really want an accurate diagnosis!

    I'll tell the neuropsychologist the following stuff - can you let me know if you think this is sufficient? Is there a "magic word" that will get him approved for testing?

    -difficult child is impulsive, distractible, too talkative, and frequently gets in trouble at school. Has rarely had a gymnastics class in which he wasn't benched. Has rarely had a Sunday School session in which he didn't get a "minus." Almost never finished the day in the "green" during K and 1st grade. Was suspended once for throwing something at his teacher (not in anger, just tossed it at her 'cause she asked him for it.)
    -difficult child has complex partial seizures and is on medication for this. When his behaviors were at their very worst, he was having uncontrolled seizures. Every now and then his impulsivity and activity level will go through the roof with no known cause.
    -difficult child seems to have a hard time making eye contact when I ask him to. He sometimes misses social cues, especially when he's wound up. Has had a very difficult time knowing where personal space boundaries are.
    -There's a history of drug addiction, depression, ADHD and possibly Asperger's in the family tree.

    Thing is, difficult child is in a REALLY good place right now. Almost all of his behaviors are getting better. I'm not sure if it's maturity, or therapy, or outgrowing his seizure disorder (this was predicted by the neuro.)

    Any advice on getting this dang testing approved?!

    Thanks,

    Jen
     
  2. flutterbee

    flutterbee Guest

    This is how it worked for me (and insurance coverage is going to vary by state).

    My daughter's therapist got the approval for a consult visit with the neuropsychologist. At the consult visit, neuropsychologist and I discussed what has been going on with my daughter. She agreed that an evaluation would be useful. She requested authorization from the insurance. The insurance responded with authorization for 10 hours of testing, but that did NOT guarantee payment. Payment was dependent on the findings. IOW, had there not been a medical finding, i.e., anxiety, and had only been findings of developmental delays the insurance would not have paid. They would have said it's an educational issue.

    We already knew my daughter had anxiety. We needed to know what was causing the anxiety because the therapist felt sure there were executive function issues going on that was fueling the anxiety and she was right. However the neuropsychologist worded it with the insurance company, they must have covered it because I never got a bill. (Insurance is provided by difficult child's dad so I don't get the insurance info and we don't have contact with him.)

    Regarding the 504...have you posted on the Special Education board? 504's don't have any teeth and really don't offer much protection. My daughter did well academically - tested above average in all testing areas and did excellent in the classroom until she got into the higher grades when more independent working was required - around grade 5. You don't need to wait until your child is failing to get an IEP. I would definitely ask Martie and Sheila about this on the Special Education board.
     
  3. BestICan

    BestICan This community rocks.

    Goodness, Heather, that's a TERRIBLE setup! How can that even be legal? Thanks for the warning - I hope I don't have to deal with that!
     
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