Ophelia, I'm guessing you've already tried this, but just in case - with some insurance policies, the code used for a referral makes the difference in coverage. For instance, you're looking for an evaluation to look into autism, but your pediatrician might make the referral under a code that doesn't specifically mention autism. I'm sorry I'm not very well-versed at explaining this, but fwiw when we ran into issues like this sometimes our ped's office was able to help, sometimes the office offering the eval or therapy was able to help with codes.
My insurance usually doesn't require referrals for coverage, but I can try it that way and see if it makes a difference. My understanding after speaking with the insurance company previously is that regardless of the reason for the evaluation, if the diagnosis comes back as ASD related, they will not cover the evaluation. This seems incredibly wrong to me. I wouldn't want to be the parent who's not expecting an ASD diagnosis, receive the diagnosis, and then have to unexpectedly cover the cost of the evaluation.
So, I will remember what you said when I contact the hospital, and will ask them about it. Thank you
