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Need quick advice on getting this authorization nailed!
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<blockquote data-quote="flutterbee" data-source="post: 157376"><p>This is how it worked for me (and insurance coverage is going to vary by state).</p><p></p><p>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.</p><p></p><p>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.)</p><p></p><p>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.</p></blockquote><p></p>
[QUOTE="flutterbee, post: 157376"] 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. [/QUOTE]
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