Is psych testing / evaluation covered by insurance ?

[Anonymous]

Is a psych evaluation / testing for potential ADHD / anxiety disorder covered by insurance ? Do you need a referral from a pediatrician ? Pediatrician said they do the basic ADHD evaluation in house but it wouldn't include deeper psych testing such as the WISC tests or any cognitive testing to get a learning profile . Any insights ?

[Anonymous]

no

[Anonymous]

If you go through Children's, it probably will be. Most private practices do not take insurance.

[Anonymous]

No, but the flex spending account could cover the out of pocket fees.

[Anonymous]

Anonymous wrote:If you go through Children's, it probably will be. Most private practices do not take insurance.

That's not always true. We went to Children's for both of our children. One kid's was covered because it was part of a neurological "baseline testing" related to another disorder (epilepsy). e.g. where are we today vs 2 years from now. My other child who had the same test with ADHD, OCD, anxiety, was NOT covered by insurance. It was deemed elective by UHC. We could use our FSA of course.

[Anonymous]

My medical neuropsych was covered and I used an in network person from my insurance company. They dx'd ADHD/Anxiety/ASD.

There is another battery of tests for learning differences like dyscalculia, dyslexia, dysgraphia, etc. Those tests are not covered by insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you go through Children's, it probably will be. Most private practices do not take insurance.

That's not always true. We went to Children's for both of our children. One kid's was covered because it was part of a neurological "baseline testing" related to another disorder (epilepsy). e.g. where are we today vs 2 years from now. My other child who had the same test with ADHD, OCD, anxiety, was NOT covered by insurance. It was deemed elective by UHC. We could use our FSA of course.

That's why I said probably. I agree that it's not guaranteed.

[Anonymous]

Ours was partially covered by insurance. There are multiple CPT codes billed and some are covered. I don’t remember the specifics though. We went through Children’s initially and they actually got submitted the claim. That was was a long long time ago so I’m not sure if they still do. Later we had my daughter and son reevaluated for accommodations through private practices and again a portion was covered but we submitted. Ask the provider for the CPT codes and call your insurance to see what they say.

[Anonymous]

Anonymous wrote:Ours was partially covered by insurance. There are multiple CPT codes billed and some are covered. I don’t remember the specifics though. We went through Children’s initially and they actually got submitted the claim. That was was a long long time ago so I’m not sure if they still do. Later we had my daughter and son reevaluated for accommodations through private practices and again a portion was covered but we submitted. Ask the provider for the CPT codes and call your insurance to see what they say.

Sorry for all the typos!

[Anonymous]

Anonymous wrote:Ours was partially covered by insurance. There are multiple CPT codes billed and some are covered. I don’t remember the specifics though. We went through Children’s initially and they actually got submitted the claim. That was was a long long time ago so I’m not sure if they still do. Later we had my daughter and son reevaluated for accommodations through private practices and again a portion was covered but we submitted. Ask the provider for the CPT codes and call your insurance to see what they say.

Just FYI, I tried giving my prospective insurance company CPT codes and they declined to say whether they would cover it. They said we would have to submit a claim to know. They did end up covering it, but I just wouldn't rely on knowing this ahead of time. Insurance companies are awful.

[Anonymous]

We have had 3 done privately over the years for different children, none were covered. It’s an expense, but well worth it. 2 went to Stixrud in Maryland and one was with Dr. Brosius in McLean.

[Anonymous]

We are about to do this, through children’s, and I’ve been notified of a $40 copay…I am a fed.

[Anonymous]

Mine was fully covered at Kennedy Krieger.

[Anonymous]

Generally speaking, if the testing is for a medical diagnosis, like ADHD, it may be covered by some insurances at some facilities. If the testing is for a diagnosis of specific learning disability, then often it is not covered.

[Anonymous]

Mine was always covered as a kid because I have epilepsy. My understanding is that if you have an underlying medical issue, it's covered.