Anyone been refused a Neuro/psychiatric evaluation by insurance?

Discussion in 'General Parenting' started by 4Tall, Mar 31, 2016.

  1. 4Tall

    4Tall Member

    I am really frustrated because my child's care team has recommended a neuro/psychiatric evaluation. And I read a lot of posts here, recommending one. I adopted my child from foster care, so he receives medication-Cal for his medical coverage. I jumped through all the hoops to request the neuro/psychiatric evaluation, but now, three months later, all that was authorized was a regular psychiatric evaluation.

    Has anyone had this experience? How did you push to get a neuro/psychiatric evaluation?

    I have filed for a due process hearing, which can take up to 90 days, but do you have any suggestions for what I can do now?

    He is 12 years old and cannot even carry on a conversation with peers or adults. The only way he can stay involved in a conversation is if he starts the topic, interrupting the current topic that is being discussed. Or if he relates a movie, scene-by-scene. He cannot play with peers either, unless closely supervised by an adult.

    There are many other issues, but I need to get this evaluation. I would appreciate any suggestions.
  2. ForeverSpring

    ForeverSpring Well-Known Member

    Did you try a neuropsyc located at a university hospital? Almost all take medicaid. That's where we went. He was also adopted and on our states form of medicaid. It was covered 100 per cent.

    Sounds like maybe birthmother drank or did drugs during her pregnancy. My son was born with Crack in his system, but is independent and doing well. Do try to find help for that exam and tons and tons of good luck. Keep posting.
  3. InsaneCdn

    InsaneCdn Well-Known Member

    Other good evaluation options:
    - Child behavioral/developmental team evaluation, usually out of a children's hospital or teaching hospital
    - PhD-level clinical psychologist with a specialty in and experience in comprehensive evaluation
  4. GoingNorth

    GoingNorth Crazy Cat Lady

    A multi-disciplinary evaluation is another route to go. You usually find these at teaching hospitals.

    They take a bit longer to complete because of scheduling all the various experts, but are very thorough.

    I had mine as an adult and it confirmed my bipolar, showed that the "odd ducks" that kept showing up on the maternal side of my family were autistic and so was I, and found two learning disabilities that I'd had all my life and just thought I'd sucked at those two things (math and writing coherently with pen and paper. I'm a demon with a keyboard and my mother taught me to type at a very early age)
  5. ksm

    ksm Well-Known Member

    Edie the insurance say why it was denied? Our private insurance denied too, but said they wanted the school to do IQ testing first. I got that done, then they did OK the testing. KSM
  6. GoingNorth

    GoingNorth Crazy Cat Lady

    My testing was free as it was part of a family study being done at a teaching hospital.
    They evaluated my mother as well, and really doubt ins would've paid for an evaluation on a 70-ish year old woman that wasn't for Alzheimer's.
  7. ksm

    ksm Well-Known Member

    Not, Edie....Did... Ugghhh, auto correct... KSM
  8. 4Tall

    4Tall Member

    Yes, and I tried to write Neuro/Psychological, not psychiatric!

    I am trying to find out from the contact person who denied it, why it was denied. We can't get any mental health services without requesting them through a complicated process. Because of adopting my kids from a different county than we live in.
  9. ForeverSpring

    ForeverSpring Well-Known Member

    Is it possible to get help in that county? I adopted kids from other counties too but was always allowed to take them where I wanted. Can you take them to good doctors in the other county? Wiw, what a mess. Maybe all states are different that way.bwe adopted in Illinois.
  10. 4Tall

    4Tall Member

    Yes, it would be possible to get it done in their county of origin. But it is 4 hours away and we would have to go to a regular md there first, to get referred for a neuro/psychological exam. The neuro/psychological exam takes about 3 - 4 visits. So, basically, it would be very difficult and my son would be very stressed at the time of the exam, due to traveling so far.