By Nathan Doty, Ph.D., and Brian Willoughby, Ph.D.
Comprehensive neuropsychological and/or educational testing has been touted as a gold-standard method for evaluating and diagnosing language-based learning disabilities (LBLD). However, such evaluations can be costly and, therefore, not easily accessible for all families. In this blog post, we provide strategies for obtaining a high-quality assessment…without breaking the bank.
Tip #1: Optimize your health insurance coverage or reimbursement
In some cases, your child’s health insurance may provide coverage for neuropsychological testing. While insurance carriers do not cover evaluations for learning issues (including dyslexia and other learning disabilities), many do cover the evaluation of other neurological, medical, or psychological concerns. Many students with reading or other academic delays also present neurologically based challenges, such as inattention or impulsivity. Mental health problems, such as anxiety, depression, or behavioral issues, may pose additional challenges to their day-to-day functioning and developmental progress. When these additional concerns are present, higher levels of coverage and reimbursement may be available.
While not all evaluators accept insurance, many large-scale or hospital-based assessment clinics do. If approved, insurance coverage can greatly reduce the cost of an assessment, with only academic portions being billed to the family. Many of Massachusetts’s larger hospitals house neuropsychological assessment clinics that accept insurance, including Massachusetts General, Tufts Medical Center, Salem Hospital, and Boston Children’s Hospital. While wait lists at hospital clinics can be daunting, we recommend placing your child on the list for the first available appointment. Such appointments can always be canceled, and all too often, parents or caregivers find themselves wishing they had reserved their child’s spot in line.
Families are often frustrated to learn that most evaluators don’t accept insurance up front. The reality is that insurance reimbursement rates are highly variable and, in most cases, quite low. Unlike larger hospitals where costs can be bankrolled, most smaller practices lack the administrative resources and financial backing to offer highly comprehensive assessments through insurance. However, practices that don’t accept insurance up front can often provide families with a paid invoice or “superbill,” which can then be used to seek any available reimbursement. Parents and families considering reimbursement for their out-of-pocket expense should inquire about coverage for “out-of-network” neuropsychological testing prior to completing the assessment. This article from the Clay Center for Young Healthy Minds may be helpful in navigating the complexities of insurance coverage.
Tip #2: Obtain testing through your public school district before seeking an independent evaluation or consultation
Public school districts are mandated to provide an initial evaluation for special education services, which can be requested at any time. By law, these school-based assessments must include a history of the student’s educational progress, evaluation of a student’s intellectual/educational potential, and assessment in all areas related to the suspected disability, as well as assessments of the student’s attention skills, participation behaviors, communication skills, memory, and social functioning. In some cases, speech/language, occupational therapy, or behavioral assessments may be warranted as well. Upon request and consent of the parent or caregiver, these evaluations must be conducted by a multidisciplinary team within 30 school days, with results provided directly to the family. Once in hand, the results of school-based testing can be provided to a neuropsychologist or other specialist for review and consultation. If additional testing is deemed necessary, it may be far less costly than a full neuropsychological evaluation. In some cases, additional independent testing may be funded directly by a child’s school district. Under special education law, families have the right to request an independent educational evaluation if they feel that school-based assessments are inaccurate or insufficient. Families looking to learn more about their child’s right to a thorough assessment should visit their state’s Office of the Child Advocate website. In Massachusetts, the website is the Advocates for Children.
Tip #3: Explore low-cost testing, advocacy, and support options available for students in need
For families with financial need, programs serving under-resourced communities may provide more equitable access to services and support. Such agencies often have well-established relationships with providers and may be able to secure low-cost or no-cost evaluations. For example, Massachusetts’s agencies are committed to removing barriers to equitable special education. These organizations include the EdLaw Project, the Trauma and Learning Policy Initiative, and the Bradford Education Project. Some larger clinics and practices also offer sliding scale, low-cost, or pro bono options to income eligible families. It never hurts to ask your clinic or provider, but notable examples include the Psychological Services Center at UMass.—Amherst and Boston University’s CARD.
Lastly, it is important to note that not all students with dyslexia or other LBLD need comprehensive neuropsychological testing. In fact, recent legislation compels Massachusetts’s public schools to assess and identify the underlying causes of a student’s learning disabilities, including dyslexia. In the hands of a skilled reading specialist, therapist, or educational advocate, school-based testing may provide all that is needed. This article may be helpful in considering whether neuropsychological testing is a worthwhile endeavor in supporting your struggling student.
Drs. Nathan Doty and Brian Willoughby are the co-directors of Achieve New England, a neuropsychological/educational assessment and consultation practice in Concord, Massachusetts.
Dr. Nathan Doty
Dr. Brian Willoughby