Private insurance vs. school district's tab for full developmental eval? - Mothering Forums

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#1 of 12 Old 09-26-2007, 06:15 PM - Thread Starter
 
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DS has been through an educational eval (psych, speech, OT, PT, and SPED teacher) and was diagnosed with SPD and developmental delays. He's in a full time inclusive preschool now, with ST daily and PT and OT each 3x/wk, and SPED teacher in his classroom.

Because no one had mentioned autism yet, and in fact when I asked the OT about it at his eval she said "get that out of your mind" I had thought we were in the "clear", so to speak. But the SPED teacher just called and they're recommending he go for the mental health eval. She didn't say it, but I know what they're looking for and my heart is sinking. I know the dx won't change who he is and all that, I know it in my head, but I can't help feeling terrified.

Anyway, there are a couple of places recommended, and I was wondering from your experiences what are the pros and cons of going private insurance vs. asking the school district to pick it up?

TIA.
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#2 of 12 Old 09-26-2007, 06:49 PM
 
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We are in the midst of going private for our second round of evals. At least that way there's no conflict of interest, and you might be able to get someone with a better rep! But I'll let those who have done the school board route speak for themselves.

Good luck with the evals, whatever you decide. Fiona
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#3 of 12 Old 09-27-2007, 11:56 AM
 
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Originally Posted by addax View Post
We are in the midst of going private for our second round of evals. At least that way there's no conflict of interest, and you might be able to get someone with a better rep! But I'll let those who have done the school board route speak for themselves.

Good luck with the evals, whatever you decide. Fiona
The first set of evals was done with my mother in law when she was taking care of DSS, and she had trouble with the therapist evaluating him loosing her temper with him, but he qualified for services in home until 36 months then he went into a full day program until he came to live with us. We moved to a new district who insisted on re-evaluating him, and surprise, they said he was perfectly normal and not in need of services. We went and got evals through private insurance and the difference was astounding. They insisted that their results were more indicative of his abilities and brushed us off. We moved again, and he tested out of speech/language therapy, but not out of ECSE. After finally getting a medical dx of autism and SPD, they're finally giving us what he needs, even if it is grudgingly. We're getting ready to move back to the town my DH is from, and they have a wonderful SPED program, and his parents are teachers in the school system, and my F-I-L is a teacher at the school where he would be going. My M-I-L is worried about DSS being put in a class with severely autistic children and pick up bad behaviors and regress even more than he did over the summer when we were denied ESY. That's one of the wonderful things about renting and (at the time) being military, it's easier to move to a new district if you're not getting the cooperation you need.

Anna
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#4 of 12 Old 09-27-2007, 01:46 PM
 
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if you go independant:
you don't have ot share wiht the shcool. if there's naything you don't liek about the reuslts, or you wnat to kepe private, you don't have ot tlel the shcoo it ever happened.

if you have the school do it:
it will be free. but they're unlikely to be the most qualified assessors in your area, and they've got a conflict of interest to NOT recomend all the services he really needs. but by law you absolutely have the right to their assesment, and if you don't like it, for a free independant assesment afetr that, so it burns me up a bit that they even suggested YOU go get one, this is THEIR job and if it turns out they do it poorly or you don't like the results, then you go get your independant one- free, but now you do have to share the results. good news is you'd only do that because it was worth it and you get way better services recomended , and a idagnosi you trust, because you've found a top-notch indpeendant profesisonal without a conflict of interest.

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and The Nurture Center Store and Resource Center 3399 Mt Diablo Bl Lafayette CA 888-998-BABY
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#5 of 12 Old 09-28-2007, 10:19 AM
 
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If the school is saying he needs the assesment then the school needs to pay for it. Then if you don't agree you can ask for an indenpendent assesment and the school needs to pay for that also.

However if you want to keep your DS's diagnosis private from the school the only choice you have is to go through your insurance company.
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#6 of 12 Old 09-28-2007, 12:25 PM
 
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our experience has been that the school district doesn't want to pay for more than they have to in services and so is inclined to recommend against services. For instance at the pre-school level the school district evaluated ds and said he's fine, doesn't need services. I then went to a neurodevelopmental pediatrician, and a private facility that does OT and PT and had evaluations done, took those reports back to the school district, had them re-evaluate ds and they said in lieu of this new information he does qualify!


You have a much better stand to take when you have your private eval to take as proof when you go in. I would recommend having your private eval done and having the school district do their own eval (which they would do anyway). But let the school know that you are also having your own eval done that can be incorporated into their evaluation process. That way you are all working together. Our school district has been open to hearing all outside reports and evaluations on my son and find them useful in creating his IEP.

Also, schools are mostly concerned with functionality in the school environment and so limit their testing. They don't look at sensory issues and in our case didn't pick up on the Asperger's at all. They mostly focused on cognitive things and some motor skills. Hope that helps!
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#7 of 12 Old 09-28-2007, 02:24 PM
 
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do SDs do developmental and education evauls? I thought the Sd would only do an educational evaul (which we had done in January)... we are taking dd#2 to the Dr Oct 9th to talk about doing more testing to find (or rule out) a Dx

~Kris mama to Alexis (15), Elizabeth (10), Andrew (7), and 1 angel
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#8 of 12 Old 09-28-2007, 03:18 PM
 
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kris, our school psych evaluator said he had "likely asperger's" and left it to us to decide to move forward and find a diagnosis. It was a total slam dunk when I wrote that *they* were obligated to pay for that, they hadn't evaluated him in all areas of suspected disability as the law says.
I took him to the independant nueropsych, I got the diagnosis, I got a report that won us all sorts of increased services, and I got the district to pay for it.

medical, developmental, and educational aren't that seperate. it's one kid, their issues effect them wherever they're at. don't let the school act like it's not their arena.

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#9 of 12 Old 09-28-2007, 03:25 PM
 
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Thanks... no one ever mentioned WHAT they thought was going on... just said she qualified for PT and a SEIT teacher and sent us on our merry way. Don't get me wrong - everyone was very nice, and respectful and whatnot... but i didnt know WHO to ask or WHAT to do next... nothing.

When i brought up to my dd#2 Head Start teacher and family worker that we were going to the Dr as we suspected she might be somewhere on the spectrum - they nodded like they suspected all along but never said a thing to us?!?!? Maybe they (her HS teacher, which is not run by the SD) are not allowed to voice that kind of thing to the parent?

Sorry about the hijack!

~Kris mama to Alexis (15), Elizabeth (10), Andrew (7), and 1 angel
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#10 of 12 Old 09-30-2007, 04:34 PM - Thread Starter
 
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Thank you for all the advice! (And hijack away, KJoslyn, it's OK. )

The school isn't requiring it, just saying he MIGHT need further eval. For my own peace of mind, I'd been considering it anyway. They say this wouldn't change his current services, but would be more for K next year.

I think we're going to go private; the place the SD will send us has a 6-9 month wait list. The place the school recommended is about 90 minutes away and there's no way the school would spring for that but it's probably the best place around.

Anyway, thank you!
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#11 of 12 Old 09-30-2007, 10:04 PM
 
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"The school isn't requiring it, just saying he MIGHT need further eval. "

well, schools can't ever require anything, but that "might need further eval" is exactly what I was referencing about their legal obligation to asses in all areas of suspected disability. that "might" means somebody suspects something.

"They say this wouldn't change his current services, but would be more for K next year."

that par tis total junk- until a qualified professional assesses him properly and writes out the recommended services, nobody can say if it would change his current services or placement.

whoever said so 1) was speculating and had no right to say so 2) might not understand that services get changed 365 days a year and there is zero legal justification to delay a needed service change.

"the place the SD will send us has a 6-9 month wait list."
that part is illegal too, by federal law they have 60 days maximum to do the assessment.


i'm not saying don't go private, just don't let the SD lie to you, and even if you choose not to push them yet just don't be underinformed about what they're supposed to be doing. wrightslaw.org aboutautismlaw.com

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#12 of 12 Old 10-01-2007, 12:25 AM - Thread Starter
 
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I remember the 60-day rule from before, back when I was first reading about all this. We live in a small city; the big developmental center seriously has a 6-9 month waiting list. There are NO appointments available in 60 days. Other eval sites might get him in earlier, but they don't have MDs on staff and the teacher is really recommending a medical opinion rather than just the educational eval he's had before.

We have one developmental ped in town; I should hopefully find out tomorrow what his wait is.

As far as his current services, I'm sure if he required more help than he's already getting we could add that to his IEP. I think what she meant by that was if they decided he needed less, they wouldn't change his IEP in *that* direction.

Right now he's classified as a preschooler with a disability. For K, he'll need something more specific, and that's what this is for.

The woman who called me was like the liaison between teachers and parents. She was working from a list given to her by the teachers, of kids who could benefit from further eval. DS's name had "Need?" next to it, rather than the "get him in ASAP" kind of note that some kids had. That's what I meant by not requiring the eval.

Thank you for all the help and the websites!
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