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Psychological assessment cost vs benefits, and more
April 24, 2014 11:09 AM   Subscribe

Our teenager had an initial interview with a psychologist that was driven in large part by poor academics. The psychologist recommended some broad based psychological assessment testing. The assessments were quite pricey, and it's clear that there's a pretty decent likelihood of ongoing therapy in addition to the assessment cost. Basically, the question is, is it worth it?

One big issue is that they (the psychologists there) don't accept insurance, and the base assessment runs $3,000, with another $500 to include an assessment for a few more things.

The type of testing is similar as shown on this site (note: this is not Teen's pscyhologist)

The current group has a lot going for it, good psychologist, very convenient, but the cost is a bit high for us.

Another option was to try and find something through our insurance, but a complicating factor is this is in the middle of a job/insurance transition.

Finally, trying to find another group, set up an appointment and everything will take time, and figuring things out sooner rather than later would be better, right?

My questions:
Is the fee quoted inline with other people's experiences?
Is there significant difference between assessment testing outfits?
How important is it to get things moving quickly?

As for the teen, the only issue is academic performance. No issues with attitude, attendance, or behavioral issues. Teen participates in and enjoys extra-curricular activities at school. The teen is a bit disorganized and forgetful, but reasonably intelligent, performs ok on tests and assessments, but just can't be counted on to turn in homework or long term assignments.

Note: I'm not looking for advice on how to improve the academics of the teen, getting Teen assessed is one of many avenues we're taking on that front. I provided it for background in case it helps in answering the primary questions.

Any help or general guidance is much appreciated.
posted by anonymous to Human Relations (24 answers total) 3 users marked this as a favorite
 
You know that even though they don't accept insurance, you can still file a claim against your insurance right? You need to figure out your insurance's reimbursement rate for an out of network specialist to see if it is affordable for you, but start by calling the 1-800 number on the back of your insurance card and ask about filing a claim.

It might take a while, and you might get a pretty pitiful check back, but you do have insurance, and due to ACA it must cover mental health care.
posted by fontophilic at 11:17 AM on April 24 [1 favorite]


It sounds about inline with costs I've seen for assessments. Honestly, though, I think it's a bit much considering that there's no good assessment for ADHD--if that's what you're curious about.
posted by the young rope-rider at 11:19 AM on April 24


Forgot to mention, that if you do go the file-your-self route, the front desk person will need to provide you a receipt with pretty specific information, including medical billing codes. Your insurance website will have claim paperwork for you to download and bring with you.

And should you go through with the assessment with insurance A, then 10 days later get into insurance B with job B, you can still file a claim against insurance A because it was while you were covered under insurance A.
posted by fontophilic at 11:20 AM on April 24


I don't think it's worth it because your description of the teen suggests they should be assessed for learning disabilities, not psychiatric issues. (Executive function issues come to mind -- he sound organizationally challenged.)

There is a joke that I really love about a guy getting castrated by his doctor to cure his severe headaches and later going to a tailor to get a nice outfit to make himself feel better after losing his manhood. The punch line is that his headaches could have been solved by a larger pair of underwear instead of being castrated.

I suspect this situation is kind of like that joke: The psychologist is all too happy to make money off of you with a solution that may provide some relief but is not necessarily in your best interest (or the best interest of the teen).
posted by Michele in California at 11:20 AM on April 24 [5 favorites]


PERSONALLY , I'd seek out other options. If there are no behavioural issues, no personality issues, no concerns over him being well adjusted, and everything else is hunky-dory then I would argue your $3500+ would be better spent elsewhere. Something geared more towards learning. Tutors or some sort of structured homework program where assignments are planned out and times to work on them are explicitly scheduled. Hell, maybe some of that $3500 could go towards some awesome incentive/reward for him if things improve?
posted by PuppetMcSockerson at 11:20 AM on April 24 [5 favorites]


Our teenager had an initial interview with a psychologist that was driven in large part by poor academics.

Caveat: I'm assuming you're in the US because you linked to a psychiatrist in the US, and talk about insurance in an American way.

Poor academics caused by psychological problems? It seems like you might want to be talking to his school about doing assessments to see if he needs special education supports in school. The upside of this is that the school has to conduct assessments upon parental request, at no cost to you; if you disagree with the evaluations, you can request independent evaluations at state expense. Would they fund this particular evaluation at that cost? Maybe not, and it might well be a less comprehensive evaluation that what you're looking at now, but it's a free first step at it to see how big the problems are. It also might get him classroom supports in the long run, if that's what he turns out to need.

To request an evaluation, contact the school and ask about the procedure for requesting initial evaluations under the Individuals with Disabilities Education Act. They should be able to tell you who to send the request to, in writing, with a specific note that you're looking for evaluations to determine if your child is an individual with a disability (including psychological problems that impair school performance). If you're not in a public school, you can request them from the local school district (where I live and work they have to perform them but that might be subject to legal differences wherever you are). Typically, after that request I would expect a meeting at the school to determine what evaluations were necessary followed by conduct the evaluations and a meeting to review.

If you decide to go this route, feel free to MeFi mail me.
posted by Bulgaroktonos at 11:22 AM on April 24 [8 favorites]


My husband recently went through that battery of all-day tests at the recommendation of his new psychiatrist. We were told up front that our insurance would almost definitely not cover it. It didn't, even after we appealed. It was a lot of money out of pocket and the results didn't tell us anything we didn't already know or that changed his treatment plan in the least.

If you suspect your son really needs the testing to determine what the next steps will be in getting to the bottom of his issues, by all means go forward. But I would not assume your insurance will cover any of it even if the doctor has recommended it and you file the claim yourself.
posted by something something at 11:26 AM on April 24


And an experienced child/adolescent psychiatrist will probably give a good second opinion. This kind of testing is something that only PhD psychologists are licensed/allowed to preform, so they tend to push it. Psychiatrists (MDs) can't preform it so they often diagnose and treat without it.
posted by the young rope-rider at 11:37 AM on April 24


Seconding that if you're in the US, your kid's school is likely legally obligated to offer this sort of testing at no cost. You will likely have to fight hard for it, but doing so would likely get the ball rolling on a number of other accommodations and resources that they can bring in to help him succeed.
posted by jaguar at 11:41 AM on April 24


Just ask if the testing can wait a while, then reassess in a few months whether it's still necessary. Tell them it's because of the job/insurance transition, if you want a neutral excuse.
posted by Lyn Never at 12:01 PM on April 24 [1 favorite]


I don't think that the expense is justified at this point. I would request that the school evaluate your son for special education services. I would also find a good therapist that works with young people regarding both academic and ADHD issues.

I believe the $3,000 could be better spent, and, as noted, some of those tests can/will be performed by a school Social Worker and/or Psychologist if you request a special ed. evaluation.
posted by HuronBob at 12:59 PM on April 24 [1 favorite]


I wouldn't do assessment with this group. It's too expensive. Did the doctor have an idea, or is it more a case of, "I dunno, kid seems okay, lets test."

Using your kid's grades to leverage testing through your school district. They have to do it, and it will be free. Just start being that squeeky wheel. See if you can get your kid's teachers to help you with this. When I taught, I referred a number of kids for testing.

You and your partner will need to be fixtures at the school, show up for everything, call teachers for frequent status updates, the whole nine yards.

If your child isn't showing behavioral issues, but is just having issues at school, a regular physical with your pediatrician, and regular assessment for learning disabilities are probably enough. You don't need a therapist or shrink on top of that.

Also, we always started with vision and hearing testing, might as well.
posted by Ruthless Bunny at 1:03 PM on April 24


$3,000 in testing seems like overkill to me if you don't have any mood/social/behavioral/specific learning issues and just just dealing with forgetfulness/disorganization/poor long-term planning: when you hear those hoofbeats the horse your psychologist should be looking for is ADHD/executive functioning, and not zebras that require a $3500 battery of tests to suss out.

I agree with those above who recommend requesting an IDEA evaluation through his school first.

Back to horses vs. zebras: there are formal test batteries that are used to identify ADHD, but I would expect the cost for such an evaluation to typically be more like $1000-2000. But before you get to that point, many diagnoses of ADHD are made on the basis of the client interview and history, without any formal testing whatsoever. A child/adolescent psychiatrist would be a good place to start; even if you have no interest in pursuing medication as an option, a child/adolescent psychiatrist should be able to recommend an ADHD therapist/coach to work with. You should be able to find an in-network psychiatrist, but given your job transition situation, you could also just opt to pay out of pocket for an initial assessment which will run in the $200-300 range (I've personally had much more positive interactions with psychiatrists and therapists who do not participate in any insurance network).
posted by drlith at 2:26 PM on April 24 [1 favorite]


Is it possible your new insurance would cover it? If so, I would definitely wait. Like said above, I would highly doubt you'd get any out-of-network payment; insurance companies love to not pay for this kind of testing. I do think the cost sounds in line with what is reasonable in this area.
posted by ThePinkSuperhero at 2:35 PM on April 24


I had a teen who had some struggles with this and that. In my experience, the only thing assessments lead to is more assessments. After you've spent the $3k plus post-assessment $500 for more assessments, and your teenager has answered 100 personal questions asked a half-dozen different ways by as many strangers, will the teenager's grades improve? No? Well then if teenager needs extra help in school he/she will of course need to be assessed by the special ed team. And if talk therapy is recommended then that practitioner will want to assess the teen. Group therapy? Just fill out this preliminary paperwork with assessment questions beginning on page three. What's that you say? Your teen is suddenly behaving rebelliously against treatment? Ah yes, we see that all the time. It's the age. The teenage brain is such a mystery, you know.
posted by headnsouth at 3:36 PM on April 24 [2 favorites]


IANYP (I am not your psychologist), nor am I that type of psychologist. But my expertise is in testing and I'm familiar with most of the tests listed at the linked site. While I am certainly not in the business of assessing children (although the executives I assess sometimes act like children, but that's a whole other story), the battery of tests listed looks a bit like a fishing expedition to me. It's so broad-based in its scope that I wonder what the psychologist is actually expecting to find. Honestly, if it were me, I would consult with some other professionals and pursue an approach that postulates and tests specific hypotheses rather than following the "let's throw some spaghetti at the wall and see what sticks" method.
posted by DrGail at 4:32 PM on April 24 [2 favorites]


There are many types of psychologist s and some focus on learning disabilities and quite frankly nothing to do with what we consider mental health. A psychiatrist and psychologist study very very different things. Even psychologists as a group study very different things. I saw this because it looks like people are mixing these things up.

I would get a second opinion before doing an expensive battery of tests. My university offered to do them for a much smaller price. Probably a plane ticket there and back a hotel room and the testing would be cheaper.

Also your school is required to help out with this stuff. If you suspect a learning disability who do they recommend ? Ask the special ed teachers who deals with their kids because they deal with this everyday and word gets around who is good.

My wife had testing done as an adult and it was tremendously helpful. But it may not be for your son.
posted by AlexiaSky at 4:50 PM on April 24


Yeah I went through this and was wrongfully put through psychiatric services when I needed help with executive dysfunction and learning disability. Those test actually don't test for a lot of that either because if your child tests well they will probably ace those tests, the tests don't test for difficulties with being able to study for a long period of time to learn something new and do mindless busy work (i.e. activities that seem poorly designed and worthless to a kid who thinks a lot and has their own interests) and it won't test for remembering things or being able to accomplish a complicated set of new tasks or remember what they are, or remember the routine of the day or or or...

I'm not saying don't do them, I'm just saying they gave me a one of those rorsache tests and then said I was immature because I said one of them looked like shera's castle. It did! OMG I still can't believe that they literally told my family the problem was that I was a "wimp" because I said that I felt my mother was weak (she is emotionally a coward and totally unavailable to talk about emotions, she has cried and told me she's sorry she just can't talk about things) and repeated the "if she would just apply herself" routine meaning I got no further help other than more and more medication recommendations that were making things worse. I needed actual help with school. Yes even though I'm "clearly capable of more".

I've volunteered in an OT clinic and saw for the first time kids getting actual help with the parts of school or learning that are hard for them! It's an actual thing that apparently a large portion of mental health service providers rather negligently seem to be unaware of. Get your kid assessed somewhere they work with learning disabilities and problems like adhd. They might recommend some things like neurofeedback or assistance with school work and planning and some help for you working to help them develop the skills they need. I would make sure to consult some people outside the school system so you can make sure what the school offers is actually helpful. If your child tests well the traditional forms of assistance like longer test times might not actually be the right supports, I haven't had any help from the school system with the kind of problems I have, such as forgetfullness or needing time in school (or with parents helping) to do homework, or needing special tutoring that involves help with the actual looking at what the homework is and processing what actually needs to happen to make it get done, (I can't do steps very well, to accomplish simple tasks) and stay on track or reminders about what is due when. I do have a friend whose daughter has executive dysfunction and she spent a LOT of time at the school demanding exactly what she felt her daughter needed and fighting against many many denials of her requests until they finally permitted the requests, so it can be done at least at some schools. I will say though that friend of mine is FIERCE and unyielding, I find her intimidating and forceful just chatting about the weather, so... be prepared to really go the distance if you want the RIGHT resources and not just a generic "additional time on tests" sort of services.

Also what's nice about using resources outside of school and seeing if they help is that your child doesn't have to go through a labeling process that claims their differences make them an ill disordered other, dealing with those labels being recorded by your school institution is unsettling and should be something that is really necessary before you go that route. If working with some specialists that work with adhd life planning skills, or homework for forgetful scatterbrained kids, you might be able to get further because there's not likely a whole lot the school can do about it (though IF your school has good resources for your child's specific difficulties, and they are really needed, it would certainly be worth using them if they would help).

Also if you haven't tried them yet, it's worth trying lifestyle changes and a focus on coaching structured routines (through the use of professional recommendations) and see if some interventions like that might help.
posted by xarnop at 5:45 PM on April 24 [2 favorites]


I was a massive underachiever. They sent me to a psychologist. It did nothing. For me it was something at home.
posted by Ironmouth at 6:31 PM on April 24 [1 favorite]


The "problem" that you have identified is a learned skill. Your child sounds like a great kid who still needs to learn some adult skills with the caveat that this behavior can be a "signal" of something deeper. Yet your description does not seem to say that...so having worked with a number of young men and women who had not yet learned this skill, the "treatment" was a careful process of teaching those skills.
Or he could be like some of the people I work with...perfectly happy and still half organized some 50 years later. I vote you save your money.
posted by OhSusannah at 7:36 PM on April 24 [2 favorites]


In my area, the relevant phrase would be 'psychoeducational assessment'. It would run $2000-$3000 (the lower end accommodated on a sliding scale - the assessments are licensed, & it takes time to administer, score and interpret them, as well as interview parents, child and teacher/s). It would involve two full days of assessment of various cognitive functions and learning skills. They'd also do at least a clinical interview to exclude any psychosocial issues that might be missed by parents or teachers, and might continue on with more formal assessment along those lines if it looked like something was up.

In the secondary and post-secondary educational institutions near me, this kind of assessment would be required to get formal accommodations - a GP or psychiatrist's diagnosis would not be enough. The people (again near me) who most often do this are educational psychologists, neuropsychologists, and some 'regular' psychologists who mostly specialize in this sort of thing. Learning disabilities organizations would be good points of contact for referrals, if you don't like the person you've found.

If you suspect ADHD and are considering drug treatment, any GP or psychiatrist could throw out a diagnosis inside of five minutes with a checklist.

I guess it depends on what your goals are, and what your thinking is around the kinds of treatment you want. If your aim is to understand what's likely to be going on, the assessment might be worth it.
posted by cotton dress sock at 7:49 PM on April 24


I understand that you are interested in coming up with solutions, but I would caution you from prioritizing a specific outcome like "turns assignments in on time." It kind of sucks, as a teen, to have parents engineering your life around achieving certain results, when you really just need, say, somebody to listen to you, or a little room to grow. With that in mind, I would agree with some folks upthread and ditch the assessment idea in favor of finding a therapist or counselor that works with a broad base of academic/youth issues.

Whether or not your kid aces their history project or not may feel like a Big Deal right now, but it will be totally forgettable in the course of their life. What matters way more is that they could trust the people around them accepted the person that they were, and that they formed relationships with people who could push them to understand themselves and the world better. Not saying every therapist would be that person, but maybe.
posted by elephantsvanish at 8:09 PM on April 24 [1 favorite]


Keep in mind that in the US, most states require someone to be a Psychologist or a School Psychologist (some states license a Masters level psychological examiner but results must be signed off by a PhD psychologist) so using the term psychologist here is accurate for academic testing as well. And yes...in the US the school district has someone who can do most of these tests (usually with a degree in School Psychology). So ask the school if they can provide testing and if the private psychologist would read the report and give suggestions. That will definitely save you money.
posted by MultiFaceted at 8:46 PM on April 24


I have a relative that did such testing. Honestly, the report/result did more harm than good. There was a huge list of "possible" problems, which relative (then in a unwell mental state) took as absolute. It just freaked out relative even more, lost all will to improve since there was sooooo much wrong.
posted by Neekee at 9:05 PM on April 24


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