Insurance vs. Private-Pay?
How to Pay for Learning Assessments?
To use insurance or to private-pay? That is the question, right? Perhaps you’ve already decided to go forward with a psychoeducational (or learning) assessment for your child or yourself. Or maybe you’re still busy comparing services, costs, and trying to determine whether and how to pay for the assessment. No doubt you’ve spent a lot of time researching options. You understandably want to find the best possible assessment service – but also at the most reasonable cost!
Somewhere during your research, you’ve probably wondered whether to pay for the psychoeducational assessment with insurance or private-pay (i.e., paying with cash, check, or credit card). What are the advantages of each payment option? And which is right for you and your family?
Both options – insurance and private-pay – have their advantages:
Insurance
- Can reduce the cost burden. Depending on your insurance plan, as well as the type of assessments and diagnosis, insurance companies may pay for some or all of the costs of testing for “medical” conditions (usually these refer to mental health or neuropsychological issues that are deemed “medically necessary”).
- Discounts are typically available for going through “in-network” providers.
- Other discounts may be available when you use “out-of-network” providers.
Private-Pay
- Insurance does not pay for “learning” or “educational” assessments. Insurance policies do not typically cover “learning” or “educational” assessments such as testing for learning disabilities. In general, insurance does not pay for psychoeducational assessments of academic achievement, cognitive (IQ) testing, or personality and temperament inventories. However, as discussed above, your health insurance might cover assessments of certain “medical” conditions. For example, depending on your insurance policy, you might be reimbursed for assessment of mental health issues or, in some cases, ADHD. Your policy might also pay for certain types of neuropsychological testing that your physician believes to be a “medical necessity.”
- In order for insurance to pay, you must be diagnosed. This is important to consider before you decide to utilize insurance. Since health insurance is part of the medical model, you (or your child) must be diagnosed with a mental health condition if you utilize insurance. This stipulation is important to understand up front, since any subsequent diagnosis will become part of your permanent medical record – possibly affecting your future insurance coverage, school options, employment, etc.
- Your privacy is protected. When you pay privately, you share an agreement with your psychologist – and no one else. With the exception of special cases (e.g., issuance of a court order, or in situations where someone’s life or safety is threatened), your records will never be released without your written authorization. Cash sessions are entirely confidential. Conversely, insurance companies can and do audit psychologists – meaning your (or your child’s) records must be made available to the insurance company and, quite possibly, various other “third party entities” (such as government agencies). Even if your psychologist is not audited, he/she is still required to submit certain information about you to your insurance company (see below).
- Only you and your psychologist determine scope of care. When you pay privately, your psychologist will work with you to formulate goals and intervention based upon your unique circumstances. These plans can be modified, continued, or concluded based on the decisions you make together – in confidence. On the other hand, insurance companies require psychologists to submit client treatment plans – which their claims departments will then decide to approve or deny. When you choose to utilize insurance, the type of assessment, results and diagnoses, and recommended treatment must be submitted to your insurance company. Their claims department will then determine whether the outcomes and recommendations of your sessions fit the insurance company’s decision-making matrix.
- You have more options. When you pay privately for an assessment, your psychologist can utilize any assessment tools that he/she believes will be most helpful and appropriate for yielding a clear and comprehensive profile. He/she is not constrained by what your insurance company will or will not pay for.
- No hidden costs. Private-pay typically involves “flat fee” rates. For example, if an assessment is advertised as $800, then that’s the final cost. All agreed upon services will be provided for that price. There are no “extra” or “hidden” costs. You will not receive any “surprise” follow-up bills.
- Often less expensive than insurance. In the long run, the cost of a psychoeducational assessment may end up being less when you private-pay. One reason is “deductibles.” Insurance companies typically require you to pay a certain amount before they will cover additional costs. If this amount (i.e., your deductible) is greater than the cost of the evaluation, your insurance policy will not pay. Keep in mind that, just because you have received an initial quote for reimbursement, this does guarantee you will actually be reimbursed (as mentioned above, claims may still be denied). Furthermore, since insurance companies direct scope of care, they may agree to cover only a limited-scope assessment. And in all cases, the insurance company will require a diagnosis. But what if no diagnosis is warranted? And what if further testing is appropriate? When all is said and done, you may be left with more questions than answers, and the total cost of the assessment process will increase substantially.
- You pick your provider. Perhaps most importantly, when you pay privately you are able to choose your provider based on “best fit” for you (and your child).
What should you do?
There is no single, best, “right” way to pay for a psychoeducational assessment. Both insurance and private-pay have their advantages. Here are a few final suggestions to consider:
- If you have insurance coverage, check your particular plan by calling the customer service number on your card. Ask the representative about the benefits of using in-network and out-of-network providers, as well as to explain exactly what is (and is not) covered by your plan.
- If you have a Health Savings Plan, you may be able to use these funds to pay for psychoeducational assessment. Check with your HSA provider.
- If you can afford to do so, use cash or check to pay for psychoeducational assessment. This ensures the highest levels of privacy and comprehensive service options.
- If you need to use insurance, get a quote from your company, pay privately first, and then seek reimbursement. Your psychologist can issue you a detailed invoice with insurance billing codes. However, keep in mind that, if you do utilize insurance, your psychologist will still be required to issue a diagnosis (and then submit it to the insurance company). But with this option, you can at least have greater freedom in your choice of psychologists.
- If you still have questions or are uncertain about the options, call and ask your psychologist. They love helping individuals and families – and they will be more than happy to provide information or answer any questions you have!
– Dr. Katen
©2016 Individual Matters, LLC. All rights reserved. Feel free to republish so long as credit is given.
Dr. Katen to Discuss Learning Differences at The Lexington School
We are very excited by the upcoming “Saturday Series” at The Lexington School: November 5, 2016.
Dr. Katen will present: “Students with Learning Differences: Navigating the Challenges.” Topics include:
- Different ways that students think and learn
- What learning differences are and how they impact learning
- Social and emotional challenges experienced by children with learning differences
- How to support your child’s unique temperament and learning style
This is a unique opportunity to:
- Gain valuable insights
- Learn helpful strategies
- Participate in hands-on activities
- Collaborate with other parents and professionals.
Parents and professionals from all schools welcome. To register, visit www.thelexingtonschool.org/Page/Saturday-Series
The Lexington School will award attendees with certificates for Continuing Education/Professional Development Credits.
- Published in Dr. Katen's Blog, Learning, Achievement, and Academics, Parenting
What is Executive Functioning and How Does it Affect Learning?
Is your child struggling in school? “Refusing” to complete chores at home? Is homework an epic battle every night? Does your child complete the homework but forget to turn it in? Does your child’s desk, bag, and room look like they were hit by a tornado? Are their emotions intense and unpredictable? Do you find yourself referring to them as “lazy”? Perhaps the reason is a weakness in executive functioning.
If a child were an airplane, executive functions (EFs) would be the pilot. While many parts and processes of a plane may be in good working order, only the pilot can set a destination, take off, steer the plane where it needs to go, address any issues along the way, and land safely. Without a skilled pilot, the plane is nothing more than a complex assembly of hi-tech parts and equipment sitting idly in a hangar.
Similarly, our brains are powerful and complex mechanisms. But without efficient EFs, individuals may find it difficult to achieve even the simplest goals. From fixing a lunch, to cleaning a room, to learning math, to organizing a school project… EFs are needed to set and reach objectives of all dimensions. Without strong EF skills, a child is essentially a plane without a pilot.
Though the term EF is often described as a singular brain function, it is in fact comprised of multiple, interconnected, complex skills and abilities—so much so that even the experts cannot not agree on a single EF model.
Dr. Thomas Brown’s model offers parents and teachers a clear and straightforward way to categorize skills, understand strengths and weaknesses, develop interventions, and scaffold success. Brown divides EF into 6 “clusters”:
- Activation (getting started, organizing, prioritizing)
- Focus (sustaining and shifting attention)
- Effort (regulating attention, sustaining effort, processing speed)
- Emotion (moderating frustration, excitement, anger)
- Memory (juggling and recalling information)
- Action (controlling pace of action and impulsivity)
The key to any successful intervention is to correctly identify the specific area of struggle. Dr. Brown’s model provides a framework for identifying and understanding which area(s) of EF your child might be struggling with so that intervention may be tailored accordingly.
Children do not wake up in the morning and choose to “fail” at life or in school. So why, then, is life so challenging at times? If you answered “yes” to any of the questions at the beginning of this post, it is possible that the culprit is a weakness in executive functioning. – Dr. Katen
©2016 Individual Matters, LLC. All rights reserved. Permission is granted to share this article with others, as well as to print or post it on other websites, so long as credit is given to the author.
- Published in ADHD and Executive Function, Dr. Katen's Blog
Creativity: The Upside of ADHD
– Frank Coppola, MA, ODC, ACG
Creativity: The Upside of ADHD (Attention-Deficit/Hyperactivity Disorder)
When many people think of Attention-Deficit/Hyperactivity Disorder, or ADHD (formerly called ADD), they tend to picture a hyper and oppositional kid who is bouncing off walls. Or maybe they envision a day dreamer who never listens. Or they think of a disorganized and habitually late adult, whose desk is a mess, and who can never remember where he put his phone. While attention regulation – and sometimes hyperactivity and impulsivity – are certainly part of this “disorder,” there are also many advantages to having ADHD.
One of the greatest gifts of the ADHD mind is creativity. The abilities to jump from idea to idea, to connect seemingly unrelated topics, and to wander (apparently without aim) inside a world of imaginative thought is a double-edged sword. In some situations, these traits can be disabling. But when understood and effectively channeled, these same handicaps become the seeds for ingenuity and discovery. “Impulsivity” can spark spontaneous and brilliant solutions. “Hyperactivity” can fuel the creative process. A “lack of focus” is an advantage when it frees a person from preconceived notions or strategies that aren’t working – and if it results in heightened concentration on more important activities and goals. Indeed, the creative juices of ADHD often produce novel and ingenious solutions, theories, and inventions.
Albert Szent-Gyorgyi, a Hungarian physiologist who won the Nobel Prize in Physiology or Medicine in 1937 and discovered vitamin C, said,
– Albert Szent-Gyorgyi, Physiologist
– Dr. Katen
©2016 Individual Matters, LLC. All rights reserved. Feel free to republish so long as credit is given.
- Published in ADHD and Executive Function, Dr. Katen's Blog
Why is My Child Struggling at School?
Attention issues, learning challenges, and social and emotional issues
Parents often feel lost, frustrated, and powerless when their child is struggling at school. Although motivated by love and a fundamental desire to help their child, parents may be unsure why their child is having trouble and what steps to take in figuring it out. There are many reasons a child may be struggling, and, although these may be obvious in some cases, for most children the root cause is complex and not immediately evident.
One underlying cause may be attention issues, which can result in academic problems, negative behaviors, and social difficulties. Academic performance is greatly affected by poor attention because it creates gaps in knowledge. In the classroom, new knowledge builds upon previously mastered material and, as the child progresses in school, gaps in foundational knowledge become increasingly problematic. Behavioral symptoms of attention issues can look very different for each individual child. For example, some children are disruptive, some stare out the window, and others present as engaged while, in fact, their thoughts are elsewhere. Since children in this latter group are not characteristically hyperactive and disruptive, they are at highest risk because their attention problems are least likely to be identified. In addition to academic and behavioral disruptions, attention issues can also result in social and emotional struggles. Children with ADHD are often socially immature and experience low self-esteem.
A learning challenge may also be the culprit of low academic performance. A learning disorder is suspected when academic achievement is substantially below what is normal for age, schooling, and level of intelligence. Not surprisingly, learning disorders significantly interfere with school performance and achievement. Beyond failing grades, these problems can also cause demoralization, low-self esteem, and deficits in social skills. Children may become disruptive in class or simply “check out.” Furthermore, undiagnosed learning disorders can impact students into adulthood when they feel ashamed and “stupid.” As a result, personal relationships and careers may suffer. Contrary to popular belief, learning disorders are not indicative of low intelligence and do not assure failure; some of the greatest thinkers of our time are believed to have had learning and/or attention deficits.
Social and emotional issues can also lead to academic problems. A child weighed down with sadness, anxiety, low self-esteem, and turbulent relationships is less likely to find the focus and motivation necessary to be successful on tests and assignments. Every individual expresses and deals with social and emotional issues in his own way – a reality which presents additional challenges to parents who seek to understand what is going on with their child.
Many times a child’s difficulty at school is not due to a disorder or attention problem, but instead relates to a particular learning environment or style. For instance, children who are advanced in a certain area, but who are not challenged to the upper level of their abilities, are at risk for disrupting class, losing motivation, hiding their talents to fit in with peers, and developing an unhealthy view of why they are different. Sometimes a child simply has a different style of learning. For example, a visual-spatial thinker (someone who conceptualizes in images, and who sees “the whole” rather than organizing information into “silos”) learns most effectively when they understand the big picture first and can utilize their non-verbal abstract learning skills. Visual-spatial students also typically have “light bulb” moments when they grasp a concept all at once rather than in a step-by-step manner. Recognizing and capitalizing upon individual strengths and learning styles are essential for maximizing academic achievement and personal growth throughout one’s life.
When attempting to understand the cause of a student’s struggles at school, a good first step is psycho-educational testing. Essentially, psycho-educational testing removes a great deal of guess work by distinguishing between “can’ts” (inabilities) from “won’ts” (behavioral choices), and by giving parents solid answers and direction. Results of testing reveal how an individual thinks and learns, information which can be used to offer recommendations based on cognitive, emotional, social, and behavioral functioning, as well as individual strengths and interests. Once parents clearly and comprehensively understand their child’s struggles, they can focus on promoting strengths, developing skills, seeking supportive learning accommodations, and collaborating with educators. Ultimately, the goal of psycho-educational testing is to maximize the child’s potential and lay the foundation for personal and professional success.
– Dr. Katen
©2016 Individual Matters, LLC. All rights reserved. Feel free to republish so long as credit is given.
Middle Schoolers, Harry Potter, and Wimpy Kids
Ten Tips for Encouraging your Middle Schooler to Read More
Whether your middle schooler likes to read or avoids it entirely, here are ten simple and effective ways to engage and encourage him to read more often.
- Connect books to life. If your reader likes Harry Potter, consider learning magic with him. If he likes Diary of a Wimpy Kid, help him create a journal. If he likes Hunger Games, go to an archery range. If he likes mystery, create a dinner mystery at home. If his book has been made into a movie, ballet, or play, go see it. If he likes outdoor adventure books, go hiking or camping. Bringing a book to life through real-world activities is not just fun, it also helps your reader connect with story and characters on a deeper level.
- Create a “book culture.” Take your reader to book signings. Go to local author events. Research an author, his background and interests – maybe write him letter and ask him questions (authors really do enjoy these). Schedule trips to the bookstore on Saturday mornings, during which you each get breakfast and coffee/hot chocolate, and read or peruse books for an hour.
- Go to a university library. Take your reader to the archives where the “old” books are kept. Imagine how much time and effort someone put into writing each one. See who can find the oldest (or weirdest) book. Look at the pictures. Smell the books. Look for ghosts. Then let your reader observe all the “cool” college kids reading at the library.
- Create a Summer Reading Challenge…for the entire family. Set a page count to be reached by the end of summer. Identify individual goals that are appropriate for each family member. Choose a fun reward to enjoy when the family reaches its goal (maybe a family rafting trip). Create a log so that reading progress can be tracked throughout the summer – review this at dinner time.
- Encourage your reader to create his own stories. These don’t have to be entirely original (you might notice they are based loosely on a book currently being read). Story-making unlocks imagination, nurtures appreciation of the creative process, and encourages outside-the-box thinking.
- Listen to books on tape. Take a minute to count up all the time you spend in the car together – on the way to and from school, the grocery, baseball practice, on trips, etc. Ask your reader to pick out a book on tape/CD from the library, and keep this in the car stereo. Every time you go somewhere, you can listen to another chapter. This offers a much better alternative to radio “noise,” helps your child transition to new activities, and provides a much needed escape from the reality of school and the dramatic lives of young adults.
- Let him read what he wants. If your reader is drawn only to Calvin and Hobbes, that’s fine. If he likes sports magazines, no problem. The goal is to encourage him to read, not to dictate what he reads. Kids are far more likely to read when they can pick what interests them. Besides, an astute parent knows that what a child chooses to read offers key information about his natural passions, interests, and gifts… Pay attention to these selections, as they can provide invaluable direction when it comes time to help him select a college major or career years from now.
- Read what he is reading… and read with him. If your reader enjoys Harry Potter, read Harry Potter. If he likes military history, read military history. And better yet, read a chapter or two aloud every night with him. This activity shows love, respect, and interest in your reader.
- Let him see you reading. If you want your child to read, model reading. Turn off the television and unplug the internet. Make a cup of cocoa and a snack, put on some classical music if you’d like, and read. Or pack a picnic, go to the park, and pick out a nice shade tree.
- Get an evaluation. If your child avoids reading altogether, complains about his eyes hurting, skips (or rereads) lines, inserts (or misses words), or has difficulty recounting what he has read…. consider having him evaluated to rule out a visual processing problem or other challenge that may negatively impact his ability to read.
Do you have ideas? Please comment below or email me with your own successes – I will compile them in a follow up blog post.
– Dr. Katen
©2016 Individual Matters, LLC. All rights reserved. Feel free to republish so long as credit is given.
- Published in Dr. Katen's Blog, Learning, Achievement, and Academics
Three Things You “Own”
Lessons from “The Ownership Yard”
This post is taken from my book “The Ownership Yard.” http://www.amazon.com/The-Ownership-Y…Read an excerpt from Chapter 1
There are three things in your life that you have total control over and, thus, “own.”
You own your:
1. Thoughts
2. Feelings
3. Actions
You do not (and cannot) own others’:
1. Thoughts
2. Feelings
3. Actions
Makes sense, right? Easy enough.
At the beginning of this chapter is a drawing of a house. Imagine you are the house.
Only what you can control is in your yard. In your yard are your thoughts, feelings, and actions. These are the three things in life that you truly own. No one can steal them. No one can use them. No one can borrow, destroy, or control them. Because you own your thoughts, feelings, and actions, you also own the consequences – both good and bad.
Outside your yard are other people’s thoughts, feelings, and actions. Who owns other people’s thoughts, feelings, and actions? You got it! They do.
Everyone owns their thoughts, feelings, and actions, as well as the consequences – both good and bad. You cannot own other people’s thoughts, feelings, and actions. You cannot steal them. You cannot borrow them. You cannot destroy them. And, you cannot control them.”
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Check out Amazon to see more of the book!
http://www.amazon.com/The-Ownership-Y…
Thanks for reading and let your garden grow!
–Dr. Katen
©2014 Katrina Katen. All rights reserved. Feel free to republish so long as credit is given.
- Published in Dr. Katen's Blog, Successful Living