Health Insurance and Learning Disabilities

Archived Q&A and Reviews

Will insurance cover LD testing?

June 2002

We are beginning the process of navigating the murky waters of learning disabilities diagnosis for our soon to be 10 year old son. Our insurance is Blue Cross, who will give us absolutly no information about what they will and will not pay for in regard to this type of testing. I have requested the paperwork from Children's Hospital to be placed on their waiting list - which is now well over 6 months long. The school psychologist has recommended (and we strongly agree) that our son be tested over the summer so that he will be able to begin 4th grade with an educational plan. This leaves us only with the option of a private evaluation - ie, one we pay for up front. We are willing to beg or borrow the money to do this but would like to hear from families who have gone this route - did your insurance company reimburse you? Any advice on how best to proceed? Thank you for any and all advice.

You didn't mention if you have a PPO or HMO. We successfully appealed our Health Net HMO to cover a developmental pediatrician for a private assessment of our then 1 yr. old. At the time, there was only one other MD in network and he mainly dealt with older children. It's burdensome, but I would try the appeal route with your insurance. Good luck. Tracy

I have a nine year old son with a mild learning disability called dysgraphia. We've known he had some problems surrounding fine motor skills and organization since kindergarten. We have tried many times to get insurance to pay anything either for evaluation or treatment and have not ever been successful. Our pediatrician was willing to try and get OT for him, through the Alta Bates Medical Group, and referred him, but was unsuccessful. When we discussed it with the kind folks at Pacificare and ABMG we were unable to even get a clear outline of the circumstances in which they would pay for OT... It was clearly limited to such situations as a down syndrome child, or a child with a physical disability.

I expect much depends on your actual insurance, but we've had no success either with our HMO (Pacificare, through the University) or through our PPO (Aetna, through a large multinational). About the best we can do is to get Medical Care reimbursement, through a tax-saving plan.

I'd guess over all we have spent well over 20k treating thisout of pocket. We have finally, through the school, started to get some remediation in the school, now that he is in the third grade. This, by the way, is not through an IEP, but through a 504 plan for a disability.

Good Luck. Oakland Mom