no ins. coverage for where to go?

Discussion in 'General Parenting' started by sjexpress, Sep 17, 2010.

  1. sjexpress

    sjexpress Guest

    After finally coming down to the fact that difficult child needs neuropsychologist evaluation and getting a referral from pediatrician, I found out that our ins. does not cover neuropsychologist. evaluations unless the problems stem from a medical standpoint....brain injuries, tumors, etc... just saying or even having in writing about all the behavioral and emotional problems difficult child is having is of no use. I can not afford thousands of dollars to pay for neuropsychologist. evaluation.
    Now I am not sure where to turn. We have been the route of psychologists and counselors with no changes and things just continue to get worse for difficult child and us. I know he is miserable that his actions cause so many problems for him and us.
    I believe my insurance will cover psychiatrists and although they may not be as good at diagnosis, I feel it is my next step. Any advice? You all have been helpful in more ways than you can imagine. Just knowing there are other families out there struggling like us makes me feel not all alone.

  2. klmno

    klmno Active Member

    Hmmm.... I thought we recently had new laws passed that required mh to be covered if physical health was by the insurance company- I'm not positive about the details or conditions or effective date but it might be worth checking into- these were federal laws, not state.

    If it is impossible to get anyone to cover part of it at least, and you can't afford it the only other two options are to try to get an extensive evaluation thru a children't hospital who will do it for training or research purposes and not charge you or to have the sd do their minimal testing, although that's never very thorough and can lead to a ms-diagnosis and inadequate treatment.
  3. barneysmom

    barneysmom Member

    Well a lot of the stuff in a neuropsychologist is neurobiological (thus, medical). Most of it, really. The place I chose to do our neuropsychologist told us to use the code for Cognitive Disorder not otherwise specified and our insurance paid. You could call around to places that do neuropsychs and see what kind of insurance codes they use. Many places know how to bill so the insurance will accept. See what's available in your town. Many large hospitals have neuropsychiatric facilities now.

    Hope it works out.
  4. nvts

    nvts Active Member

    Hi! Can you get the ADOS test done on him through your insurance? If he was to score badly on that, it would suggest autism (with your description of him it would be high functioning or Asperger's because of the great scores in school) and should then be covered under your insurance.

    Also, if you were told this information by a rep. at the insurance company I would recommend that you call back again. Often times a rep. will speak with authority and be completely wrong!

  5. Jena

    Jena New Member


    I was in the same boat as you, yet luckily my husband fiance at the time talked to them and set up a mos. payment plan pretty low via his credit card and that's how they allowed us to do it. i found honestly for us that is the neuropsychologist to not be that valuable. yet other's have had very good experience with-the depth of the testing. it can find learning disabilities, yet our's is all emotional.

    if i were you at this point i would contact pyschiatrists under your plan, take down two numbers and meet with-them alone. explain what it is you are dealing with and tell them you want a neuropysch exam yet at this time cannot afford one. now a pyschiatrists evaluation def. will not be the same yet at this point it'll be something tangible you can use and refer to.

    you will come to learn unfortunately as many of us have, you may receive multiple diagnosis's from diff. doctor's. i was stuck in finding a diagnosis for years, it just felt like a never ending puzzle to me as i'm sure you are feeling right now and it made no sense to me.

    yet what i now and for the past few years have focused on treating the symptoms and only getting into the diagnosis for matters of education and school meetings. maybe you could hook up with-a pyschiatrist and than find a therapist that does cbt. cognitive behavioral therapy. the therapist should also set up mos. meetings with-you the parent. let you vent a little and also help guide you at home as to what you should do in regards to behaviors that need to change or stop.

    stay with that team a while, bring in your peditrician also and let the 3 of them have contact, sign whatever releases you need as well as the school. it takes time i find, and consistency in treatment (which unfortunately we haven't always had) to really get to a point where you begin to see some sort of light.

    i'm sorry your struggling, i know that feeling and it's horrible. you feel so out of control of your kid and your own family. i know you have alot to do yet thru it if you can try to find some fun stuff with the family together. that's what we did, we'd do breakfast for dinner, pick a taco night. switch things up around your home a little mite add some light to a tense situation. sounds silly yet little things can work to change the atmosphere a bit.

    i wish u luck it will get better.

  6. Jena

    Jena New Member

    i agree also with what someone else wrote regarding coding for the neuropsychologist testing. has the school done testing? sorry i dont' remember?? and also look for centers around you as well. like here on long island we have the cody center. often center's will work with you for testing more than a hospital alone or a private neuropsychologist. also another route is to go to a neurologist if you haven't been yet, explain the symptoms than maybe after they do their neurologist exam they can get you into someone they know that is a licensed neuropsychologist.
  7. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I found that for me, as an adult, my neuropsychologist was really not that helpful. Actually pretty much off the mark.

    There is also something called a multi-disciplinary evaluation that is done by a team of doctors - quite often at a children's hospital, where all these doctor's will look at the whole child and give you a big picture look at your child. They will test for physical problems, psychiatric problems, psychological problems, learning difficulties...the whole shebang.

    That would more than likely be covered because it is a medical testing procedure.