Aetna & testing for dyslexia

[Anonymous]

Complete newbie here. I am looking into testing for dyslexia/dysgraphia for my DC in 3rd grade and am planning to phone some psychologists whose names I have been given. I see there are options for comprehensive diagnostic evaluations, targeted evaluations, consultations, etc. I don't believe there is an issue of ADHD (concentration and attention are good). My two main questions right now for those of you who have been through it are:

- Is it a really bad idea to ask for targeted evaluations (not ADHD or other ones) since we don't feel those things are issues and the testing is so expensive?
- Is there any route to having this type of testing that would be covered by our Aetna insurance?

TIA

[Anonymous]

Do you get reimbursed for any out of network expenses?

[Anonymous]

ADHD is often diagnosed with dyslexia. One component of the ADHD is "executive dysfunction", which may not appear as inability to concentrate but tather as difficulty processing incoming information. I would not skip assessment for ADHD even if my main concern was dyslexia. Try to see a neuropsych who will do objective computer-based testing and other standardized measures of attention and executive function as well as ADHD and BRIEF checklists that a regular psychologist would do.

BTW, it is MORE likely that your insurance will cover testing if ADHD testing is done.

[Anonymous]

Anonymous wrote:Do you get reimbursed for any out of network expenses?

OP here. Yes. But I don't think Aetna covers testing for any psychological testing related to education. I have been given a code to check with them.

[Anonymous]

Anonymous wrote:ADHD is often diagnosed with dyslexia. One component of the ADHD is "executive dysfunction", which may not appear as inability to concentrate but tather as difficulty processing incoming information. I would not skip assessment for ADHD even if my main concern was dyslexia. Try to see a neuropsych who will do objective computer-based testing and other standardized measures of attention and executive function as well as ADHD and BRIEF checklists that a regular psychologist would do.

BTW, it is MORE likely that your insurance will cover testing if ADHD testing is done.

Thanks - yes, I was getting the impression that ADHD would be easier to get reimbursed. But how to I ask that question of my insurance company ... I was only given one code for all psychological testing?

[Anonymous]

We recently went through this. Our DC has ADHD so that was part of the testing. We decided to go out of network with Mindwell after getting some completely useless (and probably inaccurate) testing with an in-network psychologist that I don't often see recommended on DCUM. At the intake meeting, we went over why we wanted testing and what his areas of strength and weakness are. Out of that intake meeting, his psychologist was able to put together the battery of tests that would be most effective. You really don't want to opt out of completeness because your recommendations will be much less effective (that was part of the problem with the in-network testing). After completing the testing, we received the receipt with all of the testing with individual codes. We were advised to submit it as "psychological testing" and to not use the word "education". We're still awaiting processing of our claim.

FWIW, I felt the cost for going out-of-network was well justified by their thoroughness and the depth and detail in the report and recommendations.

[Anonymous]

12:59 here: DC has ADHD and dyslexia. We sought testing at Mindwell specifically to diagnose the dyslexia.

[Anonymous]

Anonymous wrote:

Anonymous wrote:ADHD is often diagnosed with dyslexia. One component of the ADHD is "executive dysfunction", which may not appear as inability to concentrate but tather as difficulty processing incoming information. I would not skip assessment for ADHD even if my main concern was dyslexia. Try to see a neuropsych who will do objective computer-based testing and other standardized measures of attention and executive function as well as ADHD and BRIEF checklists that a regular psychologist would do.

BTW, it is MORE likely that your insurance will cover testing if ADHD testing is done.

Thanks - yes, I was getting the impression that ADHD would be easier to get reimbursed. But how to I ask that question of my insurance company ... I was only given one code for all psychological testing?

Call the tester you are interested in and ask him for 1) possible diagnosis code for ADHD and/or executive dysfunction, and 2) billing codes he would use for the testing linked to ADHD/executive function. You can also ask for the billing codes he would use for the other academic achievement testing. Then call your insurance company and see if they will cover the specific billing codes. Some psychologists will break the # of hours down into number used for ADHD testing and number used for achievement testing if you ask (instead of just one flat fee for "psychological testing"). FWIW, if you get turned down for the "educational testing" part of the psychological testing, you can try appealing and use the argument that it was necessary to do both ADHD and educational testing to make a "differential diagnosis", i.e. that since ADHD and learning disabilities like dyslexia can mimic each other, it is necessary to test for both to make sure that you know if the presenting symptoms are ADHD or something else.