A:
Psychological assessment is typically
covered under the medical coverage of your insurance plan when
your child is referred by a physician. Psychological assessment
is usually covered if testing was conducted to establish a diagnosis
as the basis for medical treatment, to evaluate the functional
impact of a medical treatment (baseline testing), or to assist
in selecting a treatment. For example, for some children the use
of medication may be the best approach when behavior problems
occur, while for other children the use of a behavior plan or
psychotherapy is the best approach. Neuropsychological assessment
is usually covered if your child has learning or behavior problems
and a history of brain injury, or has a current medical problem
that may be affecting brain development. Many insurance plans
will require a letter from your child's physician, indicating
the medical necessity of the assessment. Medical necessity means
that the physician needs more information to help provide care
for your child. Please note that most insurance plans will deny
coverage for assessment, used to establish an educational diagnosis
(e.g. learning disability). Medical insurance carriers view this
as responsibility of the patient's school. However, coverage will
often be provided if the question, prompting testing, is the relationship
of the academic problem to some other medical problem or medical
treatment.
