Neuropsychological testing is not medically necessary

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So I have been referred to a Neuropsychologist for assessment, but she tells me that Insurance generally will not cover it and expenses are typically $2,000--though she would be willing to offer a break and do it for $1,500.

I don't have that kind of money sitting around, so I checked my insurance policy carefully:

What the !@#?

The american insurance system is a joke. It's about making money for shareholders, not taking care of people. We should replace it with something better.

I have cigna and it covered neuropsychological testing for my daughter.

Call their member services and talk to them. I had to do it but eventually they covered the test. It's a giant pain in the rear but it has to be done.

Thanks, Kate!

Do you remember what argument(s) you had to present to get approval?

I spent three hours on the phone with Cigna on Friday, only to have them refer me to a psychiatrist who was not a specialist in autism and could not do an assessment.

Thanks again, I thought I had reached a dead end with this.

Switch to Blue Cross Blue Shield. They covered all of it for me. I only had to pay like $150 out of pocket.

I've been on the phone with Cigna and they say they will not cover it if the test is just to diagnose AS/ASD.

If the test is to diagnose or rule out something else that falls under "medical necessity" but neuropsych testing is not one of those... They seem to think that autism and asperger's only impact children and the issue is only about school.

It's quite frustrating.

I can only assume that they paid for the testing in your case, Kate, because it was coded with some other diagnosis.

Different states have different laws, so CIGNA may actually cover this in most states.

37 States mandate coverage for at least everyone under 18 to 22, with a handful of states like California mandating coverage for all ages.

I live in Massachusetts and can not find a neuropyschologist even listed on the Cigna website to do a neuropysch test anywhere in the state although Cigna tells me it's a covered test if needed they have no contracted providers. Any thoughts?

Could it be that they are being wilfully ignorant because that is what benefits them, and they have found that they can get away with this attitude? Effectively they are gate-keeping. Politically, it is a form of marginalising a minority group. Commercially, they have made a decision in their own best interest, and ignored the huge amount of research that shows the very complicated impacts of ASD on body and mind. Their self-interest doesn't surprise me - insurance companies which sell their products with bleeding heart advertisements can be very hard hearted to vulnerable or minority clients.

We saw that here (in New Zealand) starkly, in another context after the Christchurch earthquake of 2011 which wrecked not just buildings but lives. And the insurers' behaviour was appalling in its callous disregard for the victims. However that's another story..

Did they really use "just" Adamantium? It would not surprise me if they did; that small word speaks absolute volumes about their attempt to trivialise and discount ASDs generally as well as adults with ASD in particular. It is very concerning. Of course you are disturbed, I am too at invalidations like that, even when they don't directly affect me. Indirectly attitudes and ignorance on that scale have a flow on effect on all of us.

Can you get the shrink to write up the referral in a way that will convince the insurance company to cover it? Like saying you need to rule it out for a diagnosis of a mental illness or something?

In general, I am not willing to suggest potentially unethical practices to others, even when the system of rules is broken or corrupt. I have an aversion to it. I would go along with it if this was proposed by an expert in the system, but not initiate it.

In any case, since posting that 2 years ago, I found a psychiatrist who did a low-cost ($600) assessment. This actually put significant strain on my budget, but I had to know, so I was seen and diagnosed with ASD/Aspergers Disorder under DSM IV criteria.

I am keen on data and would like to compare current testing with the many tests that were done on me when I was 12, but that's just not within my economic reach at the moment, or likely to be so, given my priorities as a parent.

I suspect that changing technology and the unsustainable insurance model in the US will lead to a revolution in the delivery of medical services in the next 5-10 years and some tests which have been prohibitively expensive will be within reach of most people after the change. I hope this will help others who come after us.

I don't even think it's unethical. If a doctor writes a referral then by that very action they have shown they do think it's important. They just haven't used the wording that would get that specific insurance company to pay for it but a different insurance company might cover it with the exact same wording.

A few years back I needed physical therapy but the doctor wrote out the referral in a way that got it rejected by the insurance company. The insurance company would either only cover or never cover Occupational Therapy (I can't remember which). I called her up and she swapped (out or in) the word "occupational" for "physical" in a new referral and then it was covered. She knew I needed it but couldn't keep track of all the different things that all the different insurance companies would reject for all her various patients. A patient with X insurance would be covered but a different patient with Y insurance would not be covered with even the exact same referral. So it's always worth a call. But in your next paragraph it's a moot point anyway.




Yes I think so. New technology could drive down the cost of some tests and some tests could move to OTC. After all, you didn't used to be able to buy a pregnancy test at the drugstore for just 10$ or so.

Agreed. A similar situation occurred with my daughter recently. The insurance company said that a procedure coded one way was not covered, but the same procedure coded another way was. So, I called the doctor and explained the situation to them. The doctor felt the procedure should be covered. And agreed to resubmit under the acceptable procedure.

It now occurs to me that the doctor may have been telling me to do this, and I was not picking up on it.

I had a $3000 neuropsychological assessment done about 8 months ago, but it was covered by the government job training program I was briefly a part of. Without this assessment, I probably wouldn't have gotten the documentation I needed to sign up for AiSH. Even though I was first diagnosed when I was 5/6 years old, the papers from that diagnosis have long been lost.

The Albertan healthcare system isn't perfect, but it's one of Canada's best.

Possibly a change from human-administered to computerized tests will help with cost.
Humans are often paid several hundred dollars per hour to administer a simple cognitive test, while computers will do it for cheaper, more precisely, and without the load of social interaction to interfere with test results.