Gifted Issues Discussion homepage Forums Identification, Testing & Assessment Insurance

I'm wondering if Insurance has ever paid/co-paid educational testing (including specialized tests to rule out specific LD's) for your child. I think I heard somewhere that it might kick-in if an LD is suspected, but I may be mistaken. I know there is a great disparity in policies. I'm just trying to get a feel for the process.

Most insurance policies do not cover this kind of testing on the grounds that it is educational, not medical.

In fact, we just had a psych eval, specifically were concerned about LD/ADHD, and the psychologist told me up front that insurance doesn't cover these tests.

Good luck!

I have blue cross blue shield ppo and they are covering the testing. The educational psych we found is an in network doctor!

Our insurance covers testing for LDs/developmental disabilities. I would not call it "educational testing" when you ask them; I'd make it clear that you think a disability is involved.

There is also county funding available here through two agencies: the department of developmental disabilities and the bureau of medical handicaps. They'll undoubtedly be called something else where you live, but the point is that there is sometimes money out there if you ask.

DeeDee

Both DH and I have health insurance plans with good coverage. Each cover any psychological service up to a maximum of $750 per person per year. DD's initial testing in grade 2 was completely covered. All receipts were made out as 'psychological services' and for the parts of the psych ed where the parents were included, like the initial interview and results appointment, the receipts were provided in DH and my names. Between the three of us and double coverage, everything was covered. When DD was retested this year for dyslexia, it was again 100% covered. We are in Canada and I am not at all sure how our insurance plans differ from those in the U.S.

When my nephew had his psych ed, my sister's coverage was less than stellar so she scheduled the assessment in December/January so that she could bill to two different calendar years and maximize their coverage.

Our insurance covers psychological services such as counseling but not testing such as IQ testing. The psych who dx dd11 with ADD was covered but she didn't really do much in the way of testing save for reviewing prior IQ and achievement tests, having teachers and parents fill out some sort of scale, and meeting w/ dd and me.

Even after years of dealing with it, I'm not sure how one goes about diagnosing things like ADD or dyslexia other than comparing IQ and achievement, possibly looking @ patterns on IQ subtest scores, and subjective things like interviewing parents, kids, and teachers or having them fill out rating scales. We were told that the IQ/achievement piece wouldn't be covered even if it was for the purpose of looking for a LD.

Our ds and dd have both had neuropsych testing covered by our medical insurance (ds has had two rounds covered); the key was it was not covered under our mental health benefits, but was covered by medical, and to get coverage we needed a referral from our pediatrician. If we'd just been looking for IQ/achievement testing alone that wouldn't have been covered, but we were referred for the evals because our children were showing signs of anxiety and stress and it was suspected that they might have disabilities that were fueling the anxiety etc. DS was diagnosed with a disability which impacts learning, dd was diagnosed with a vision challenge.

Our insurance has denied coverage for things like OT for ds on the grounds it's an educational challenge and should be addressed by the schools. My understanding is we could appeal that decision if we were able to prove a medical cause for the disability, and our neuropsych has suggested in ds' case we might have reason to suspect a medical cause.

The thing that was really helpful for us when we pursued our first neuropsych eval was to ask the neuropsych's office admin person for advice re insurance - they had worked with our insurance company before and knew exactly what we needed to do to have it covered.

Best wishes,

polarbear

Cricket, I agree there is a large degree of subjectivity and observation built into these diagnoses, but fwiw our ds and dd have both had testing beyond IQ/achievement to determine if they had dyslexia and/or ADD. The results of the computerized test were used in combination with parent/teacher rating scales and neuropsych observation as well as pediatrician interviews/observations. The ADD testing was a computerized attention test. DD had huge challenges learning to read and she had quite a few different types of tests given through a school that specializes in dyslexia and related learning disabilities; it's been so long ago I don't remember the names of the specific tests (other than Gray's Oral Reading?) but recall that they tested a bunch of very specific types of different tasks in order to tease out where her challenges were and how she would learn best.

polarbear

Yeah, the second set of testing we paid for out of pocket was done w/ a psych w/ expertise in LD who also gave dd the GORT (Gray's Oral Reading Test). She insisted that there were no LD and no ADD despite a lot of red flags including the GORT where she was in the top quartile for comprehension and lowest quartile for speed. The next psych we saw who reviewed prior testing looked at the same stuff and said ADD and anxiety.