Question about ADHD/ADD Eval

aforst

We met with a behavioral psychologist last week to discuss some issues our 6 y/o has been having in school.  After hearing what we had to say, she thought that it would be beneficial to do an evaluation on him to see what we could uncover.  I received an email from her today that our insurance has agreed to cover 5 tests.  However, she wants to do "a total of 8 units."  This is going to cost us $750 out of pocket for the additional 3 units.  She says that she typically collects the first half of that at his eval (in two weeks) and the rest at our follow up meeting (the following week).

We do not have $750 to give her in the span of 1 week.  I haven't talked to DH yet, but I'm thinking we would want to discuss this with her.  I'm just wondering if anyone has any experience with this?   I don't know what tests are covered and which ones insurance is not covering.  I plan to ask her what the additional 3 tests are and why insurance is saying they aren't necessary.  I feel like we're going to have to tell her that she either gives us more time to pay her or we can't do the additional 3 tests. 

I'm just worried that this is going to hinder getting him some help if he needs it.   

hopecounts

Find out what tests she wants to administer which will allow you to get info about them and better judge their importance.

Certain  tests would be worth paying for to better allow you son to get the appropriate diagnosis (or not) and others would be NBD to skip.

We paid 1500 out of pocket for DD's ASD eval, it sucks but sometimes you do what you have to do. We were fortunate that we had our E Fund to access but if not a CC may be necessary or ask her about a payment plan. 

aforst

hopecounts said:

Find out what tests she wants to administer which will allow you to get info about them and better judge their importance.

Certain  tests would be worth paying for to better allow you son to get the appropriate diagnosis (or not) and others would be NBD to skip.

We paid 1500 out of pocket for DD's ASD eval, it sucks but sometimes you do what you have to do. We were fortunate that we had our E Fund to access but if not a CC may be necessary or ask her about a payment plan. 

I totally agree.  I'm hopeful she'll be flexible on the payments. 

aforst

@-auntie-  The school is currently doing something, but it's not really an "eval" I don't think.  They have different "tiers" for behavior.  He is on tier 1 right now which is a behavior chart that his teacher uses in the classroom.  She recently went to a committee to advise of some of his issues and they suggested he be moved to tier 2.  The difference in the tiers is that they take a deeper look at the data.  Every week she will be emailing the school psychologist about how many days Vincent met his goal.  The committee will review this once a month.  If they think he's making progress than they keep doing what they are doing.  If he doesn't, they talk about making changes to their interventions or possibly moving him to tier 3.  I'm not sure what tier 3 consists of though.

It sounds like we might need to reach out to the school psychologist directly to find out what our options are in conjunction with what we are doing outside of school.

MirandaHobbes

I would ask for more specifics as to what each appointment entails. I'm generally wary of doctor's offices- not that I don't trust their opinions or guidance, but that I always feel like they are trying to ding my insurance for as many appointments as possible. For my son's psych eval they scheduled out 4 appointments over a month period. The first was to lay a groundwork of what to expect. I cancelled the second because they said it was for "any additional questions I had"; they agreed it was not necessary and usually only utilized by parents who previously didn't have a diagnosis. The third was the eval itself. The results were given to me then and I was given the ample opportunity to ask the doctor questions. The fourth is to "go over the results" again, but it isn't even with the doctor it's with the intake therapist we first met with, so they told me I didn't need that appointment either and that if I had questions I could just email the doctor.

My insurance does cover all these, so I will probably attend the last one and bring DH since he couldn't make the eval. But sometimes it feels like a racket!  

hopecounts

I didn't realize the school hadn't evaled him. 

If the school isn't evaling him then you need to request an eval IN WRITING as soon as possible.

They have 60 school days to eval once on notice so depending on the district can take a while. 

Otherwise they may keep putting it off until it's April and they don't have to act until the following year at which point you are desperate and get a private eval that they can then use and not pay for or provide the eval. 

Princess_Lily

What your school is doing is a response to intervention (RTI). This is prepping him to receive a 504/IEP, is my guess.

Tier 1 is typical mainstream student

Tier 2 is where a behavior chart specifically for your child is in place, a chart specifically geared to his needs - not a general classroom chart

Tier 3 is where a FAB & BIP is initiated and he receives a 504/IEP.

My son is in this - he's in tier 2 and has been for about a month, but next week he will be moving to tier 3. The BIP will start then, have a review and then an IEP is initiatedinitiated if needed. Have you received any forms yet to start an assessment of any kind (FAB)?


We had a private eval done with a psychologist, but all tests were covered at 100% as long as doc was in-network

kcisthebombdotcom

-auntie- said:

Have you asked the district to evaluate him? If he's having trouble in school- academically, socially or even behaviorally, the school should evaluate in in all areas of suspected disability at no cost to you.

Of course, the district can only offer an "educational dx"  and is very unlikely to be on par with an eval done by a clinical psychologist, but it is one option. If you know what scales the private psych wants to do, you can sometimes cobble together a plan to get the district to do the ones the insurance company won't pay for. Sometimes it's worth discussing this with the insurance company.

Do you know what tests she wants to give? A good psych eval will not just look for ADHD but will R/O other conditions that mimic or exacerbate ADHD behavior- poor sleep, anemia, ASD, anxiety, specific LD, borderline IQ.

This is pretty much what we did. Our developmental pedi did some of the testing and the rest was done by the school psychiatrist. I would see if that's an option.

aforst

Princess_Lily said:

What your school is doing is a response to intervention (RTI). This is prepping him to receive a 504/IEP, is my guess. Tier 1 is typical mainstream student Tier 2 is where a behavior chart specifically for your child is in place, a chart specifically geared to his needs - not a general classroom chart Tier 3 is where a FAB & BIP is initiated and he receives a 504/IEP. My son is in this - he's in tier 2 and has been for about a month, but next week he will be moving to tier 3. The BIP will start then, have a review and then an IEP is initiatedinitiated if needed. Have you received any forms yet to start an assessment of any kind (FAB)? We had a private eval done with a psychologist, but all tests were covered at 100% as long as doc was in-network

We haven't received any forms from the school at this point.  I have reached out to the school psychologist to see if they provide evaluations for attention issues.  I'm still waiting to hear back.  DH also left a message for the BP to see what tests she wants to do, what these 3 extras are and why insurance is not covering them.  Hopefully with more information, we can make a better decision on how to proceed.  I may be back once I know what they are to see if you ladies can offer any insight.

I truly appreciate the feedback, it's very helpful!

aforst

bubba2b said:

For the school. Keep things in writing. Even a followup letter to a phone call is a good idea. Also request a MFE in writing early in the school year. Alternatively walking in the door with a neuropsych evaluation in hand may be a more effective route.

I sent her an email so I can keep a trail of our conversations.  What is an MFE?

Shayna0182

It can get pretty expensive.  We received the school testing for ds, where he received an educational diagnosis for ASD.  We sought a private medical evaluation through Easter Seals, here in Indianapolis, and they determined that he has adhd, but are on the fence on the ASD.  We have another appointment with them in April, where I think they'll be more in agreement with the school on the asd.   I want to say we paid about $400.00 for the private eval. 

aforst

Ok, so I reached out to the school psychologist who just kept referring us to the school counselor.  My DH talked to her today and the gist of it is that the additional services that the school could provide would consist of rating scales and observation of his behavior within the school setting.  She said that the school "does not have the authority to make a diagnosis if it is an ADD or ADHD concern."  She basically said if it's diagnostic in nature, it has to come from a medical professional.  The school has things in place to help him once that diagnosis is made.

We also talked to the BP and she said that she wants to do 8 "units" and our insurance is approving 5 "units."  Apparently, this is what our insurance usually approves.  1 unit = 1 hour.  She will spend 2 hours with our son having him do various tests.  The other units come from the 3 forms that DH, myself and his teacher have to fill out (so 9 forms total).  The other "units" are comprised of the time it takes her to evaluate those forms and also our follow up appointment with her. 

At this point, it seems that we are going to have to pay the $750.  The good news is that she's willing to let us stretch that out a little bit.  That's a lot of money, but he definitely needs some help that we can't provide.  Everything we have tried at home and school is not improving the situation.  We just want him to be successful and happy. 

aforst

AA0417 said:

aforst said:

Ok, so I reached out to the school psychologist who just kept referring us to the school counselor.  My DH talked to her today and the gist of it is that the additional services that the school could provide would consist of rating scales and observation of his behavior within the school setting.  She said that the school "does not have the authority to make a diagnosis if it is an ADD or ADHD concern."  She basically said if it's diagnostic in nature, it has to come from a medical professional.  The school has things in place to help him once that diagnosis is made.

We also talked to the BP and she said that she wants to do 8 "units" and our insurance is approving 5 "units."  Apparently, this is what our insurance usually approves.  1 unit = 1 hour.  She will spend 2 hours with our son having him do various tests.  The other units come from the 3 forms that DH, myself and his teacher have to fill out (so 9 forms total).  The other "units" are comprised of the time it takes her to evaluate those forms and also our follow up appointment with her. 

At this point, it seems that we are going to have to pay the $750.  The good news is that she's willing to let us stretch that out a little bit.  That's a lot of money, but he definitely needs some help that we can't provide.  Everything we have tried at home and school is not improving the situation.  We just want him to be successful and happy. 

I didn't deal with the school in my own ADD dx (as I was in college at that point), but from my understanding (others will have better knowledge), a school can give an "educational dx" but a medical dx from someone in the medical field (whether you go with the psychologist, a neurologist, or someone else) would be needed in order to get a rx component to tx (as is often beneficial in addition to the behavioral and/or therapeutic aspects). I don't know if the school is not explaining that well or if they are trying to talk you out of pursuing evaluation. You will need to write a formal request via paper letter to get them to actually go forward. In some ways, it may be easier to have a dx in hand first, but in some ways it can help work towards the medical dx. It is great that the psychologist is willing to work out a payment plan if you end up going that route. I know it sucks when the timing of medical needs lines up with the timing of having insurance that isn't awesome and/or when finances aren't as great as you would like. Good luck!

@AA0417 Thank you!  The school psychologist and counselor have been very communicative and helpful.  The school psychologist is going to observe him in the classroom for several days and present her findings to our behavioral psychologist to help aid in her evaluation. 

Having to shell out that much money is never fun, but we will do what we need to do to help him.  One thing I can say is that his teacher, the school psychologist, counselor and our behavorial psychologist are all willing to work together and everyone seems to be very interested in helping him be successful.  I feel very blessed and thankful for that!