3 Considerations When Selecting a Private Evaluator

I’m currently on hold with my insurance company, so I’ve decided to multi-task and write my first blog post.

The timing of this post is relevant since I’m waiting to find out what (if any) portion of a neuro-psychological evaluation my insurance will cover for my son. His testing is out of date, so it’s time to go through that lengthy (but valuable) process again.

The first time my son was tested, my husband and I were disappointed with the evaluator we used. The psychologist conducting the evaluation just didn’t connect with our son. The report he wrote was troubling as well, since it contained an unsupported diagnosis which made its first appearance in the very last paragraph of the report. As a special education teacher, with a master’s degree in the field, I feel like I really dropped the ball by selecting him. So, I’m determined to ‘get it right’ this time.

If you have a child with a special need of any kind, you probably know that finding supports to meet your child’s needs is not easy. This time around, we have a great referral from our doctor (ticking the expertise and relatability boxes), but that evaluator doesn’t take our insurance. From previous calls to our insurance company, I know that our plan covers 100% of the cost of an educational or neuro-psychological evaluation as long as we use someone who is part of their network.  

I feel like I should be jumping for joy that insurance will cover services at 100%. My husband thinks I should. (He’s playing the voice of financial reason on this one, while I’m stuck on using this specialist.) Yet again, we’re in a situation where our needs compete. We’re being forced to decide between expertise, relatability, and cost. Yes, there are other excellent evaluators out there who may meet all our needs, but couldn’t it just be easier for once?!

So, what now?

Since the evaluator has the expertise and specialization to connect with and work with my child, it’s time for another attempt at making the financial piece work.

My insurance company will pay 70% of “allowed” costs after we have met either my son’s or our family’s ‘Out of Network Deductible’. So, I will now:

  • Determine the amount of my son’s Out of Network deductible
  • Find out how much of his deductible has been used to date
  • (Hopefully) get the appropriate billing codes from the private evaluator so the insurance company can tell me what the allowable cost of a private evaluation is
  • Ask the private evaluator whether a billing plan is available

If that doesn’t work for our family? Then, it's back to the drawing board.