[kdk545]

Some of you mentioned having experience with neuro/psych evals in my previous post about my son's impulsive behavior. And I was wondering a couple of things....

Did any of your insurance companies cover the cost of this eval, or is it always out of pocket?

Did you have your pediatricians refer you for the eval and if so, did that help with the insurance willing to pick up the tab?

Did any of you do it through your local school districts? My son could qualify under the early intervention services, but Im not sure we want to go the school district route versus the Childrens Hospital route.

Thanks. Just trying to get the ball rolling on this.

[Linny]

I'm not usually in this forum, but have had some experience with neuro/psych evals......however, for older children.
Still, we also have two little ones (both adopted as babies) who've been, and one still is, involved with early intervention services; so I hope my suggestions may help.

It's common for insurance companies to NOT pay toward these kinds of things, because they are expensive; and oftentimes, you can get these evals done through the services you already have (EI). (That's been our experience.)

(We have had one for an older child and we ended up paying for it out of pocket initially.......then, because he was in residential, to our surprise, DCFS ended up paying the tab.)
But, generally,if an insurance company WILL pay, they like to have the pediatrician give referral for this.
I'm not sure how old your child is...but if he's very young, having a psych eval may be difficult to do---or at least, be very conclusive, KWIM?
Still, I believe I'd ask both entities. It's usually hard to get one done without the referral from EI first. And truthfully, you may find that EI will do a more conclusive one, than elsewhere. I hope this helps somewhat...

Good luck to you.

Sincerely,

Linny

[angelkisses0102]

With DS, his first couple of neuro evaluations were paid for by insurance because he had a minor skull fracture and was hopitalized. A couple of years later he was then referred through our pedi to a local children's hopsital to see the pedi neuro and insurance would have paid...but DH lost his job (and insurance) before he got in to see him. So we were forced to go through the school district. THE BEST THING WE EVER DID. DS was fully evaluated (for free) and the school district psychologist was very knowledgeable about PI children and their common issues. She was the first person to ever acknowledge that I was right about DS all along.

At that point he finally got some diagnosis that allowed him to begin getting the therapies he needed. Last September he was enrolled in a special preK program through the school district...a language based special needs full time classroom setting that has really been like a miracle for him (totally free and even his time spent in a private typical developing Pre-K is paid for by the state...he spends a couple hours a day with typically developing peers). Just this week he was evaluated by a private OT, which is being paid for through our insurance as DS needs help learning and dealing with 'activities of daily life.' To get his private ST covered...the diagnosis of swallowing issues was given by the pedi. ...since he does have eating issues. (We are on the wait list at the same office that he is getting his twice weekly OT.)

I am also having both kids evaluated this summer for ADHD this summer...again the pedi is referring us (although I do not need referrals for our plan) to a developmental psychologist.

I called the insurance company and asked...what do I need to do to get OT covered for DS? We have a great plan...but we have a $4000 deductible (DH's hospital stay in January took care of most of that) and we are now working on them paying 90% and us 10% for the next $1000 out of pocket and then they pay 100% of up to 60 sessions of OT, PT, &/or ST PER diagnosis. So we are taking full advantage of that this summer. Even though DS will still not be in a typical Kindergarten next year...he will be in Kindergarten and will be getting the tools and therapies he needs to eventually be placed in a typically developing age appropriate grade level (which is the goal of the program he is in.)

While I was speaking to the insurance company I made note of the exact terms she was using and had the pedi use those words...and told the OT what she needed to put in her notes so that DS's OT sessions would be covered (he needs to show minute improvement each session...tiny, tiny, tiny advances forward.) So, I would talk to your insurance company...if you don't like the answers, ask to talk to someone else. I really feel that our insurance company reps wanted to get DS covered...which helped.

Early intervention and early assistance through the school distict...before the children are in Kindergarten can make a world of difference for many children. My lil' guy is a shining example.

Good luck.

[GCS]

It seems like every situation is different. We brought our boy home at 3 years and had him evaluated through EI six months later. He did very well and did not qualify for any services.

A year later (so he's 4 and a half) and I am still thinking that we are missing something. I go to the school district and hear again that he really doesn't qualify for services.

But my research is leading me to believe that there is more here and I can't say the people we'd met with to date had any experience with IA kids. So I call a local IA doctor and he recommends a Pedi Neuro Psych that has 2 IA kids herself (one from Russia) and has worked with many other IA children.

She is the one who gave us the answers we needed. With our boy the problems were certainly there but were subtle and so he just got passed by. The other thing with our guy is that he's very savvy. He reads your face, lips, looking for hints. He had no problems in school and was right on target developmentaly but was really struggling in situations where he was overstimulated. He had a hard time with transitions and it took him longer and lots of repetition to learn completely new concepts. We were worried that we were going to have learning problems in school when he got older if we did not find a way to help him.

In our situation we could have made our lives and his much easier if we had gotten this evaluation done earlier.

Our dr. did not take insurance but filled out all appropriate paperwork for you to submit to your insurance company. I knew our insurance company was not going to pay it 100%. His OT was covered although it took 6 months of constant calling for me to get him on an OTs schedule. They are very difficult to get on the books with where we live. His speech therapy was not covered. I could have taken his evaluation to the school district and have gotten him an IEP for speech. He needed speech for conceptional work as part of his SID diagnosis which I already knew would be out of the range of the speech therapist at our school since she was completely unfamiliar with it. I found a speech therapist at the office of our OT and she worked with our son for 9 months. He graduated out of speech this month. Since our insurance would not cover his speech I was able to work out costs with the therapists group. They did not have to deal with the insurance company and got paid the day of services so they gave me a lower cost. He's 6 and a half now and finishing Kindergarten. He does very well in school and his other activities. Our lives are so much better!

Good luck!
Christina

[SingleMama2B]

Hi.... I can only talk to an older child's eval. My DD came home from Russia when she was 8 years, 3 months old. She had several things going on that I needed to find out about. Though her behavior was fine (hyper to the max, but not destructive), I knew something was going on. I DID have the Ped give me written referrals (even though my insurance does not call for it with specialists), but to be on the safe side since we needed to see a Geneticist, Ped. Neurologist, Endochrinologist, and several more.

My insurance did pay for all of the specialists (excpet for the co-pay of course). She has been diagnosed with Mild FASE, ADHD, and few other. My DD now (for a year now) goes to Weekly Neuro Occupational Therapy with a specialist. My insurance is covering up to 32 visits a year at 100% and the copay. I am extremely grateful, as each visit with this specialist is $351.00! OUCH! It is amazing though how far DD has come with therapy! This specialist has made such a difference for my daughter! I do (even though it is not required) get a Ped (doctor's script) every 6 months for this specialist. There has NOT been any questioning that way.

I would go with getting the referral and/or script right from the start!