In your experience, will insurance pay for testing for learning disabilities or is my only bet...

[Guinevere]

Hi all,

I've posted here from time to time, as I have several children with SN. This post is about my 6 yo DD, who is in 1st grade and has been dx w/an anxiety disorder.

I've known for a long time that her brain was wired "differently" from her older sibs, and have watched her struggle with things that they never did: learning letters and numbers, speech (she has been receiving ST for 2 yrs. now), and now that she is school-aged, reading, writing, math, pretty much everything. :( She struggled a bit in Kindergarten, but had a wonderful teacher and made enough steady progress that she stayed at grade level, so I held off on getting her any additional interventions, not sure exactly what was going on, you know? I chalked it up to her being a bit of a slow starter.

This year has been really hard, though. She has a new teacher, who is by nature rather stern and very stingy with compliments, but more importantly, she is obviously used to dealing with either typically learning or gifted children and has nothing positive to say about my DD and her lack of progress this year, yet she keeps using the same strategies with her, and they're.just.not.working. Meanwhile, my DD has gone from a bubbly, self-confident child who LOVED school to a timid, fearful child who cries every.single.day. at home and in class because "she can't read and she hates school." :( At 6, she's being turned off learning. That's just not okay.

FWIW, she'll be moving classrooms on Monday, thanks to some long talks with the principal. I'm really hoping that her new teacher (whom some of my other kids have had before and is a very warm and supportive person) will go a long way towards repairing her fragile confidence, but the academic struggles remain a key issue.

The principal worked with DD twice in the past week, in both reading and math, and confirmed what I've now suspected: she almost certainly has a learning disability (likely dyslexia, but it could be something else, or something more.) The plan at the moment is for both her classroom teacher and I to offer her different strategies targeted specifically at her deficits, with the principal, who is also a master teacher, consulting (should note here for sake of clarity that DD attends a charter school that offers an alternative curriculum and I homeschool half of it.) But there is no plan at this time for her to be tested through the school district for an official diagnosis or to end up with an IEP. Why? Because she's technically not behind "enough" yet to qualify. And if our intervention helps her, she might not ever get far enough behind to qualify.

HOWEVER, I'm not a spec. ed teacher (although after 6 kids and various diagnoses, I am certainly an official "momologist" and can speak knowledgeably on a wide variety of issues, lol) and neither is her classroom teacher, nor the principal. None of us are certified in dealing with dyslexia or the like. And I feel that DD may require more specialized instruction than we can provide her. But unless she really "fails" in the school system, that support is apparently going to have to come from a private source. And I'm very concerned about our ability to pay for it. DH is currently unemployed, and the kids receive Medicaid. My DD Sophie, who has Down Syndrome, has an IEP and receives a number of therapies, but they are all provided either through school or through her insurance, so we have no out-of-pocket costs. And her diagnosis was made at birth, so this situation is new for me.

So, finally, my question: will insurance pay for DD to be tested for a learning disability? And if so, would it also pay for her receive services? Or is my only option going to be for her to fail "enough" to qualify for testing through the school?

Has anyone else been in this position? Advice, insights, please...

Kind regards,

Guin

[Peony]

 Our insurance covered nothing related to learning disabilities. The evals/tesing as well as DD1's therapy, we have to pay for ourselves. We attempted to go through the local school district but they do not recognize dyslexia as a dx, only that she needed additional assistance in reading. If it is recognized then they would have to provide services for it, they refuse to look at private evals. What they wanted to offer children like my DD1 and what she actually needs are two vastly different things. A group of children once in a week with one teacher helping them getting extra time reading wasn't going to cut it. From what I have read on other threads here, some have had luck getting things covered, others not so much

[KCMichigan]

I would say you seem to have a good support at the school.

First, no *most* insurances will not cover testing for dyslexia/learning disabilities in our experience. I had kids that had ADHD testing and neuropsych testing done for other reasons that was covered by insurance (ADD/ADHD is considered medical). But I dont know of any students that I worked with that had insurance cover it, but this may vary by state as well (even same plans such as Blue Cross cover different things in different areas).

Our school also would look at independent evaluations, but then always did their own as well and used those for their goals. (unless it was an independent evaluation post IEP dispute- which is different situation.) We had a few times that a parent 'edited' an  independent evaluation when they brought it in, so schools can be hesitant to use that information.

Dyslexia is usually not recognized by the schools--rather they use the term learning disability- specific(reading, writing, etc). Legally- that is what is covered (learning disabilities) and specified in the IDEA.

Age 6 is tough for a learning disability to be recognized. At that age- there is such a very very large range of normal. Age (young) 6 is K level (even if child inparticular is in 1st grade) in some areas of evaluation since withe Sept cutoff dates, a child may turn 6 jsut as K starts. A K students that does not know letters/number is not unusual and on the range of incoming skills. For a  6yr 1st grader, that would be 'behind' but not a big enough gap for a Learning disability dx since most testing is normed by age (not grade) when used for achievement purposes- a 'young ' for grade students may be behind, but not enough to qualify for services for a learning disability. Also , a lot of brain maturation occurs before age 7/8 and it is harder to tell developmental differences and true learning disabilities.

First, you can request free testing through the schools. Do so in writing. Your DD does not have to 'fail' first. Legally, the schools have to test students per parent request. They will not look at dyslexia rather they will find out if there is a big discrepancy between her ability (IQ) and her achievement (how well she does in certain academic areas). If there is a large gap (usually 1.5- 2 standard deviations) then they will place her on an IEP for learning disabilities in the areas she showed a deficit. Often schools will do RTI first though- which is what it sounds like you and the principal may be working toward (RTI is simply interventions that are documented and tried before testing/placement for Spec.Ed) More recently, some schools have had students that do not progress w/ RTI get Spec.Ed services w/o a large discrepancy in achievement and ability. 

Second- she does not need to fail before you request testing/RTI. She may not qualify, but you never know. If she does not qualify, you can rerequest testing again next year (12 months from first eval). No matter what, testing will give you a better understanding of where she is at.

Being at a charter school- I am not sure how they handle Spec.Ed, espc since it is 1/2 homeschool format. I would ask the principal how they handle Spec.Ed  and/or testing (some areas have inhouse testing done, others hire out). They also may or may not follow the RTI model (it is becoming more popular and most of the schools I am aware of are moving in this direction, if they have not already).

Third, specifically look for curriculum that has been proven to work well w/ learning disabilities. Orten Gillingham, Math U See, Explode the Code (reading), Touch Math----these are all programs I have used w/ students that have learning disabilities that have been successful. I chose the program based on the individual student- they are all good for students that may struggle w/ reading or math.

HTH. I would also see if a new teacher helps...sometimes that makes all the difference if there are already conflicts with the current one.

Have you looked into getting a 504 for anxiety and/or working with a school social worker for anxiety?? I have met many wonderful school social workers that have helped kids work through crying at school/anxiety/etc.

[Lisa1970]

6 is too young to DX dyslexia. I know a lot of people with disagree, because their child was DX'd with it, but in reality, the way the test works and having to be certain stanines off, and such a wide difference in abilities at this age, the testing would not be accurate.

That being said, my insurance did pay for testing.

[melissa17s]

Call your insurance and ask.  Your insurance card should have their 1800 number on it.  Ours covered it with a copay, but everyone's insurance is different.  

[Emmeline II]

Originally Posted by Guinevere 

So, finally, my question: will insurance pay for DD to be tested for a learning disability? And if so, would it also pay for her receive services? Or is my only option going to be for her to fail "enough" to qualify for testing through the school?

Has anyone else been in this position? Advice, insights, please...

Kind regards,

Guin

I am not experienced with Medicaid, but my PPO allows us to choose any doctor on the plan and pays X% after deductable for anything other that the visit fee. I would do what KC suggested, while also finding out what Medicaid covers as far as testing for LDs. Having a helpful, caring teacher helps. Last year ds' teacher really had no idea what to do with ds and his Aunt confirmed our suspicion that she was not well suited to teaching K. His current teacher is awesome;o)

[chiefmir]

In our practice (neuropsychologists) there is huge variability in what is covered by insurance.  Some (personal choice, keystone heath plans, medicare) have wonderful benefits (for our practice at least, since my boss is on their panels) and the patients only pay their specialist copay (between 5 and 50 dollars) for what is essentially a 2500 dollar plus evaluation.  Others cover like 50-80% of the eval cost after the patient/family have met their out of pocket deductible for the year.  Others cover a certain percent under out-of-netword benefits.

That said, being at a Charter School (at least the one I work in and the one my DD goes to-- two different schools in two different states) means that all the the relevant public school special ed laws apply.  RTI is very very useful to gather data about a child's learning needs and about the possible need for testing (if appropriate strategies to individualize and maximize the strategies used to teach them fail to make expected gains). 

I would recommend seeing what happens as the new plan is put into place with your DD, but definately ask for an "official" plan to be drawn up between you and the teacher/principal and relevant others)...this is not a legal document, but you should all work together to identify several specific educational goals (i.e. sight words, phonic skills, reading fluency, etc) along with a list of the specific interventions that will be u sed (and not just more of the same that hasn't worked so far) and how/when DD's progress will be evaluated.  If she does not make the documented expected gains in a certain period (we usually do 8-12 weeks) then she should be tested.

Also, at any time, y ou CAN request in writing that DD be tested, and the school has to comply (for us, it is 60 calendar days from our reciept of the permission to evaluate form).

good luck!

[karne]

NO.  My experience is that insurance would not pay for educational testing for LD's.  The practices we spoke with when we were first looking would do an initial eval, but you needed to clearly state that you would be financially obligated should insurance reject the (thousands of dollars worth) of testing, coding, etc.  On top of that, where I live, schools will not accept the suggestions of the the final report unless a school visit has been made, and observation done-here that was several hundred dollars.  

I haven't read all of the replies, so I don't know if you have an eval requested through the school yet.  If not, I would do so because while 6 might be considered is young for a dx., the school isn't going to dx. dyslexia anyway.  You may be able to look at a 504, if she doesn't yet qualify for spec. ed services.  Either way you are creating the assessment/intervention/plan documentation she'll need.  Data is very important.

I would also wanting there to be more of a firm plan.  There are very thorough and successful programs for reading such as Wilson, etc. that can be implemented, but require consistent implementation.  We did this w/my dd as part of RTI, before her LD was formally dx (she has dyslexia).  

Good luck.  We have traveled this path and I know it requires lots of advocacy.

[Cinder]

We have united health care, it covered Travis' developmental testing minus $160, $50 per visit co-pay (our specialist co-pay) for when he went and $60 office visit charge not covered at all for the intake appointment that just dh and I went to. 

[Karen Hickey]

My daughter was diagnosed with Autism and we had a $3,000 test done by a Neuropsych to evaluate her IQ, determine her strengths and weaknesses on her learning style & give us a diagnosis.  After much back and forth with United Healthcare, they did pay the bill in full.  So I have to say, while I'm not crazy about United Healthcare they did the right thing by us in this case.  This was a PPO plan.  We are now on a HMO plan, (Tufts) and while we like them a lot I doubt they're going to pay to have her retested.  It needs to be done because she is entering high school in 2012 but of course I will call to find out.  If not, we may switch back to United Healthcare and keep our fingers crossed they will pay for it.  We live in NH and our school district takes these evaluations very seriously and they have a lot of weight while negotiating terms on her IEP.  Really it should only be a matter of a couple of phone calls to your PPO to find out if they're going to pay for it.  I agree with the others, 6 is very young.  The severity of her learning disability will reveal itself over time as school work becomes more complex and social ques become less concrete and more abstract.  You'll understand a lot more in a few years but you won't completely understand it until well into middle school regardless of how many tests, opinions and evaluations she recieves.  The evaluations my daughter recieved while very young were quite grim, depressing and scary.  Today, I am happy to report that after a lot of hard work and therapy she is in a MUCH better place...even the Autism diagnosis was dropped and we are now looking at a language based learning disorder and ADHD.  So in other words, with much hard work by you and her teachers things could look much better in a few years. 

[chiefmir]

I know this is an older thread, but a few things came up at work recently and I wanted to add to my reply.  Maybe if its not applicable to you and your DD anymore it can help someone else in a similar situation.

First of all, definately get as much detailed info as possible from your insurance... but if you want to consider neuropsychological evaluation, the fastest place to get info to start out with may be by talking to that office/doctor directly.  For example, my boss (we are all doctorate level neuropsychologists) just led me through helping a family schedule testing with some good info.  He knew that the insurace they currently had did NOT ever pay for testing related to ADHD symptoms/diagnosis or specific learning disabilities.  However, since the child had a preexisting diagnosis (speech and langauge impairment, which is sounds like your DD does too, since she had St for 2 years) the insurance company would cover evaluation under that diagnosis code.  Other issues (ADHD, LD, mental health) would all be assessed since it is a full evaluation.

Second of all, I know that I said you could write a letter requesting an eval any time and the school has to legally comply.  That is all true... but there are a few reasons why you might not want to do that right away, if it seems like the school is generally working with you and DD (and from your post, it seems like they are).  first of all, it really is true that it is very difficult to diagnose LD in 6 year olds.  I DO test 6 year olds in school, but it is VERY rare that they come up for testing due to only learning concerns... and even more rare that I diagnose an LD at that age.  Partly it is because- like you said- an LD is generally "diagnosed" from a discrepancy between ability (usually IQ) and achievement.  There are other ways to do that (specifically response to intervention) but most schools/districts still mostly use the discrepancy model.  At a very young age, the amount of academic skill that a child is "supposed" to have to score in the expected ranges on the achievement tests given is pretty basic, so it is hard for them to fall well below that (especially in your DD's case, if she was on grade level last year and still at least close this year).  Secondly, a lot of learning is still impacted strongly (even more so than when the kids get older) by developmental factors and a lot of that can sometimes "even out" in the first few years of school.  Not saying that is at all the case in your DD's situation, but just another reason why the dx of an LD isn't very common so young-- since there are many more kids who struggle with some aspect of school early on than there are kids with true disabilities.  So, it may not be that the school is trying to put off testing or anything like that. 

Also, as a charter school, they may have agreements in place with the home district or the other districts that kids come from that impact their decision to recommend testing at certain points.  For example, in my school's charter (and this was/is NOT something we like--it was put in place when the school started at the insistance of the home district and we are constantly trying to change it) there is a rule that kids from the home district can only be tested (Initial Evaluation) by the district's school psychologists.  (later on, if a kid is identified with a disability, I can conduct re-evaluations, though).  That also means that the home district decides who they will test and when, to a certain extent.  While it is true that a district can not ignore a parent's written request for evaluation, they can review the the information that is then sent by the charter school (we call this the referral packet that must be sent) and decided whether or not to do the testing.  (most schools rarely opt not to test b/c they'd theoretically have to defend that decision in Due Process later on).  So, while your DD might very well be evaluated right away if you submitted a formal request, that may cause problems next year if she DOESN'T qualify right now (and she very well may not) because if she really began to struggle 6 months later, it would not be unheard of or even unlikely for a school/district to refuse to conduct a second evaluation (at the time that she might really  actually be in the most need of diagnosis and intervention) so quickly.

One more thought-- if your DD has speech therapy, she should already have an IEP, right?  As long as she has an IEP, they can add other (non-speech) goals as needed.  As I said before, I rarely find/diagnose an LD in kindergarten/1st grade kids (more often if something is there it is speech/langauge, ADHD or developmental delay) but our speech pathologist regularly and often does diagnose speech and language impairment.  A decent sized subset of those kids may go on to develope reading problems later since reading relies heavily on underlying langauge skills.  Very often in my evaluation reports, after I summarize that kid A has a speech and language impairment but does not currently meet criteria for a learning disability, I often write something along the lines of: "although student A does not currently meet criteria for diagnosis with a specific learning disability, speech/langauge skills clearly impact the development both academic skills and of appropriate classroom behavior.  It would be appropriate to include IEP goals, as needed, that address any academic/behavioral issues related to the deficits noted above (i.e. reading, reading comprehension, writing, word problems, social skills, etc.)"  you can always request an IEP meeting and request that academic goals be added, as speech and language skills have a clear impact here.

Sorry that was so wordy... hope it helps!

[beenmum]

We have had issues getting even an IEP when my DD was 6. She was finally tested last week for Irlens, even after the request was made in September by her Opthomologist.

My finding is that they will test only if the teacher decides that your child has an issue that requires testing.

You can try private funding for tests, or pay out of pocket. But seriosuly at 6 any type of testing for certian LD's such as dyslexia wont really be reilable. At 6 they are all transverting letters and words and having difficult processing written info.

Usually they wait until age 8. They tested my DD last week and she had just turned 7. But the teacher requested it. So that holds more weight then me or her optho requesting it.

[Guinevere]

I wanted to thank everyone who gave me their valuable input and give you all an update on what's been happening since I posed my question.

DD did switch teachers, which worked wonders for her emotionally. The daily sobbing and meltdowns before school stopped after only a few days in her new class, and now, four months later, she is back to her bright and bubbly self and loves school again. :) Her new teacher is a gem, and happens to be dyslexic herself, so has been fantastic with DD. And we are staying in her class again next year, hooray!

Academically, the concerns I had at the beginning of the year have only been further confirmed. She was tested in our district-wide standardized testing back in February and that time around, scored a 45% in math and significantly below grade level in reading -- and both scores were LOWER than what she had tested in the fall. This wasn't really news to me, though, as I was watching her struggle for hours without progress on home assignments. Her academic performance overall is very inconsistent; one day, for example, she may read aloud quite well, and the next, she can struggle with the exact same text as if she's never seen it before. In math, she couldn't pass out of a "pre-addition" game that is part of our school's core math curriculum (it involves building 5s through 10s with all the various number combinations,) but when finally promoted to addition, she can now add 6-digit numbers over 6-digit numbers with carrying, etc. without any problems at all. But she still can't tell you what 2 less than 7 is. So she's sort of all over the place, lol!

Anyway, the results of the testing in Feb., combined with how much she was struggling in class, DID trigger her qualifying for testing through the school district. Now, with that said, we're still waiting for the testing to happen, since the paperwork involved is a mile long: hopefully, it will happen over the summer, so she can have an IEP in place for the fall. And after further consideration, we made the decision to retain her in 1st grade again next year. Knowing we would have a long wait for district testing to happen, I also contacted a local organization that works with kids with language disorders, using the Orton-Gillingham method (which is sort of the current "gold standard" treatment for dyslexia, I've discovered) and had her assessed by them: she qualified for their program and will begin tutoring over the summer. The program is free. Double hooray! :)

So I don't know for certain that the district testing will show a LD (although at this point, despite her young age, all my instincts say she clearly has one), but at least I feel like we're on the right track to get her targeted help. Since I first posted, I have now gathered a whole list of people in our area who do private testing, should it come to that, and several work on a sliding fee scale, so that's good to know, as well. Oh, and DH got a wonderful new job last month, so with any luck, any out-of-pocket testing we might need to do will no longer send us into major debt. Triple hooray! :D

I want to thank everyone again for sharing their knowledge and experiences; I learn so much from the collective wisdom of this board!

Thanks,

Guin