Referral for Autism Diagnosis?

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I finally found and called up a neuropsychologist willing to accept my insurance and do a testing for Autism (but not until August). She said it would require a referral from a therapist, or some other shrink. When I told her I didn't have a referral, she said, "Okay, you can come in for a consultation with me in April and I can give you the referral."

I really liked this idea. Rather than having to find a shrink, go through a myriad of sessions, and try to convince them to refer me, it can be done by the same doctor actually doing the testing, no third party.

I spoke with my brother and he found it odd. He asked: How can the same doctor write a referral for her own test? If that were the case, why even bother with a referral. Isn't it going to look strange that she referred you to herself?

I hadn't thought about this. Does anyone know anything? I assumed it was all legalese, that insurance needs a piece of paper to justify the test proper, regardless of who issues it. But it is odd. Usually, a referral comes from one party for something suspected, but beyond their scope and the client then goes to a specialist. Like my brother asked, "If the cardiologist requires a referral to see him, but can write his own referral without going to a primary doctor, then what's the point of even having referrals?" My brother finds it sketchy. I was just excited to finally find someone relatively close that says they can diagnose Autism in adults.

ALSO: For those of you who were diagnosed as an adult, did it require a referral? If so, did the referral come from the same doctor that diagnosed you?

from what you've explained here, it seems like she's referring you for the actual diagnostic test/assessment process, not necessarily referring you to herself. my assessment did not require a referral (i also didn't use insurance, so that's a different process), but i hadn't seen the person who did mine before either, so i met with her beforehand. the testing in itself is a process that has to go through several steps and assessments, so how you are framing this seems legit to me. you could always call around to other places and just inquire how their process works to see if it is similar to this. or, just get some clarification from her with the exact wording she is using?

Last edited by jogashill on 18 Feb 2023, 7:14 am, edited 1 time in total.

In the UK a referral from a family doctor (GP) is needed for a NHS autism assessment. This is free, but usually has waiting lists and it can take a long time - in excess of a year in some cases - to be assessed. For a private assessment there is no need to get a referral of any description. It is difficult to get an assessment on private medical insurance as an adult here, so its hard cash only for most people. I paid £900 ($1,080) for mine, but the waiting time was only 3 weeks.

The OP and I are both in the U.S....things might be different in other nations!
Oh, also keep in mind I studied computers! My opinions on this only qualify as slightly informed opinions.

I'm guessing a licensed neuropsychologist would qualify as a "licensed psychologist". If they work with Autism and plan to apply ADOS or DSM criteria then it would seem to me that it would be a credible, official assessment.

I did not use a referral. I tried to use a referral from my insurance company but they did not know what they were talking about! Their referrals were to providers who did not do Adult Autism Assessments and their guidance to me on finding a provider to do the assessment was wrong.

After abandoning the guidance from my insurance company I found a licensed psychologist in my area that worked with Autism, took patients my age, and agreed to assess me for Autism. But I was working outside my insurance provider's processes! After my out-of-network assessment I submitted the bills to my insurance providers and got partial reimbursement. Your insurance company's processes might require a referral which would, I assume, ensure there was a reasonable reason for you to get the more expensive service in question. That is, that it was reasonable for your insurance provider to pay for the autism assessment. I'm guessing a provider, a neuropsychologist for instance, could reasonably do in initial screening to determine if there was a good reason for you to get a more expensive service...even if it was from them.

If you follow your insurance provider's processes you should, ideally, minimize the amount of money you have to pay.

P.S. While there may be more than one acceptable way to do a formal Adult Autism Assessment I hope your assessment is similar to mine. It was kind of fun!

Yes, but a reader from the UK might be unsure about how it works here. Also, comparing national systems is often enlightening.

Thanks for the replies. I assumed it was legal jargon. In order for insurance to accept the testing in the first place, they need a referral from someone, even if it's the same person doing the actual testing. (Out-of-pocket doesn't apply, as you're paying for the whole thing, no need to appease an insurance company.)

Unless I'm mistaken.

Anything I should ask before being tested, like which criteria is being used?

The referral is purely for insurance purposes. The insurance requires it in order to pay for the test. It's just bureaucratic red tape, nothing more. It doesn't mean anything. It's just the way that the billing codes have to be written so that the insurance is allowed to pay for it. That's all it is.

You don't really need to ask anything prior to being tested. But I will you what I did which helped a ton. I read Tony Attwood's book, The Complete Guide To Asperger's Syndrome. Every time I found something in that book that applied to me and that I could relate to either in my childhood or as an adult, I wrote it down. I was able to give the diagnostician a six page single spaced document with examples from my entire life, from early childhood to the present (the day of my diagnosis) showing real life examples Autistic traits and symptoms. They said that was EXTREMELY helpful in my diagnosis. In fact, it's one of the things that helped the most.

Last edited by skibum on 24 Feb 2023, 5:50 pm, edited 1 time in total.

Actually, you goto a doctor to get a diagnosis! The ONLY time you "need a referral", is if the particular doctor's diagnosis will be used for the referring doctors diagnosis, or you need to have a specific doctor give you a referral, and they can't do the diagnosis.

For example, if you went to a cardiologist, and they needed to send you someplace for an MRI, or your insurance company requires you to deal with your family doctor first, and THEY must write a referral.

Not necessarily. It all depends on what kind of insurance you have. I needed a referral for my diagnosis.

If that's what's required by insurance, do it. Sometimes you have to jump through certain hoops. I have an initial autism assessment set up with a neuropsychologist for March of this year. She said it will be a quick appointment and will be covered by insurance. She said she then has to get approval for the longer appointment where she'll actually decide whether I have autism. To me, it seems an open question: I definitely feel I'm on the wrong planet and know that I'm neurotypical. But my symptoms may not be sufficiently severe to warrant a diagnosis.

When I went for my assessment I collected stuff I thought might be useful and gave it to them.

A six page letter explaining why I wanted the assessment.
- The specific incident that caused me to wonder if I was Autistic
- My AQ score
- A very high-level chronology of my life (birth, education, jobs, etc.)
- A list of the personal records I had that I thought might be relevant
- People who could provide additional insights about me (my Dad and bride)
- A not-too-long list of Autistic "things" that applied to me

And then a pile of records I picked:
- AQ-Test
- Various personality tests I've taken (I'm an INTJ!)
- Report cards and transcripts
- Standardized school tests and college admission tests
- A resume

Plus the only thing I am certain the psychologist looked at:
<=>A journal my long-deceased Mom had kept for my first year after birth.

I don't think you need to know a lot about how you will be tested...beyond that they will use ADOS, for instance. Understanding how to test you is the Assessor's job, not yours.

Your job is to be cooperative and honest.

(And, the test was kind of fun! You might enjoy parts of it!)

I suspect health insurance needs a piece of paper justifying an Autism test in the first place. The only point of contention was if the same doctor administrating the test could write a referral to themself. Out-of-pocket and non-American commentators, thank you, but you have no helpful advice to give.

To the few who seem to understand, this appears to be legalese. I'm just surprised insurance companies don't say, "Hey, the doctor writing a referral is referring the patient to himself?!" I'm happy if this is the case, if they don't question it; I'm just surprised it doesn't tread more bureaucratic water.

As to insurance, here is what my future neuropsychologist said last month: Anthem Blue Cross of California would cover a short initial appointment. She’ll then submit paperwork to have a longer appointment covered.

I didn’t received receive a referral to my neuropsychologist.

My neurologist has asked that I get a new Autism diagnosis so that he can measure my neurological and cognitive decline since I was first diagnosed eight years age. I needed a referral for that as well as for my original diagnosis.

A lot of it is insurance bureaucracy, but there's also likely the issue of being able to find somebody with the qualifications to conduct a proper neuropsych exam and rule out as many of the other possibilities as possible. Unfortunately for one reason or another there are some types of doctor that are very hard to find and others that are just about everywhere. An exam that takes at least double time time of other typical exams is going to need more professionals and with the increased awareness of what ASD can look like and the various individuals like myself that were missed as children, and the increased difficulty of getting an accurate picture, it's going to be more time consuming.

I was personally greatly annoyed last time I went through the process that I couldn't get an appointment less than 6 weeks out and then they canceled a day or two before and gave my appointment away without bothering to confirm that they knew what I was asking for. I then got to wait a few more weeks for an appointment that was much further away for my appointment.

IIRC, I was stuck making the arrangements myself, so as annoying as it might be to need a formal referral, you'll hopefully avoid having the appointment canceled last minute and given to somebody else.

The whole system kind of sucks sometimes, but hopefully over time as the condition is better understood and the backlog of undiagnosed people starts to clear that it will get better.