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  1. #1
    ArizonaGirl is offline Platinum level (1000+ posts)
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    Default Tell me about Developmental Pediatricians

    The pediatrician initially sent us to a Psych NP to be evaluated and medicated for ADHD.

    We currently have a diagnosis for ADHD, but the Psych NP and I think that there is more going on (she mentioned ASD, or a mood disorder) and she wants to have a complete evaluation and an IQ test done.

    I finally found a provider that she recommended and am waiting to hear back from them.

    I guess I am wondering what to expect at the appointment...

    How extensive is the testing, etc?

    My insurance has no "IN-NETWORK" developmental pediatricians so they told me that they would treat the dr I chose as an in-network provider because there isn't one that is.

    However this physician doesn't bill insurance it is private pay only.

    How much does this usually cost and has anyone had luck getting reimbursed by the insurance company?

    TIA
    Lindsey

    Married to DH June 2005 gave birth to Shawn December 2008 and Lilian August 2012




  2. #2
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    My DS1 saw one, but our situation was different so I'm afraid I can't answer your insurance questions. Our pedi is part of a larger health system and they have a few developmental pediatricians on staff. The wait time was shorter than for other specialists I've tried to get my son in to see.

    The dev pe met with me one week, did the eval with my son the next (I think it took 2 hours? It was 3 years ago, when DS1 was 5-1/2 and had just started kindergarten. I think I was in the room with him for the evaluation). I filled out several questionnaires and DS's teacher did the same, prior to the eval. It did not include an IQ test.

    We had a more extensive neuropsych eval done by the psychologist in a different health care system (the one we waited a long time for!) later that year. That included the IQ and other tests.

    Check with your insurance, but if they will agree to cover the doctor as in-network, I would think that you can submit your receipt for reimbursement. You would have to pay the dr upfront but then get the $$ back.

    DS1 also has an ADHD dx, but he sees a psychiatrist to manage his meds. We see her every month, so that might be a hassle with your insurance if you are planning to do med managemnet though this physician. Just a thought.

    HTH

  3. #3
    Gena's Avatar
    Gena is offline Emerald level (3000+ posts)
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    DS has been going to a Dev Ped since he was 2.5 years old for autism and other disabilities. She basically acts as his medical case manager.

    During the initial evaluation process (which took nearly 6 months), the Dev Ped ordered some of the tests and gave referrals to other specialists for other tests. She ordered the initial blood work, which included genetic testing, metabolic testing, and checking some of his vitamin levels. She gave us referrals to neurology for an EEG, audiology for hearing testing, and psychology for the ADOS test (Autism Diagnostic Observation Scale). She gave us paperwork to complete that included medical social history and the GARS test (Gilliam Autism Rating Scale). The Dev Ped got all the reports from all the other specialists as well as reports from us and the school. She made the official diagnosis of autism, but closely consulted with other specialists, particularly the psychologist.

    DS sees the Dev Ped once or twice a year. She checks on his progress, his growth and development, and any medical concerns we have. When new issues arise, she orders tests and/or refers us to other specialists. For example she referred us to the geneticist when testing found a chromosome anomaly and ordered an MRI and referral to the neurologist when we discovered DS has face-blindness. She referred DS to the psychiatrist for ADHD symptoms and worked with that doctor to determine the best medicine for DS.

    The Dev Ped does not do IQ testing. When we decided to have that done, it was done by his psychologist.

    We have never had an issue with insurance. The Dev Ped and the other specialists are all at the local children's hospital and are all in network. Scheduling is a problem, however. We were on the waiting list for about 5 months before our first appointment. Even now, we have to schedule appointments several months in advance. It's very frustrating at times.
    Gena

    DS, age 11 and always amazing

    “Autistics are the ultimate square pegs, and the problem with pounding a square peg into a round hole is not that the hammering is hard work. It's that you're destroying the peg." - Paul Collins, Not Even Wrong

  4. #4
    ArizonaGirl is offline Platinum level (1000+ posts)
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    Quote Originally Posted by Pepper View Post
    My DS1 saw one, but our situation was different so I'm afraid I can't answer your insurance questions. Our pedi is part of a larger health system and they have a few developmental pediatricians on staff. The wait time was shorter than for other specialists I've tried to get my son in to see.

    The dev pe met with me one week, did the eval with my son the next (I think it took 2 hours? It was 3 years ago, when DS1 was 5-1/2 and had just started kindergarten. I think I was in the room with him for the evaluation). I filled out several questionnaires and DS's teacher did the same, prior to the eval. It did not include an IQ test.

    We had a more extensive neuropsych eval done by the psychologist in a different health care system (the one we waited a long time for!) later that year. That included the IQ and other tests.

    Check with your insurance, but if they will agree to cover the doctor as in-network, I would think that you can submit your receipt for reimbursement. You would have to pay the dr upfront but then get the $$ back.

    DS1 also has an ADHD dx, but he sees a psychiatrist to manage his meds. We see her every month, so that might be a hassle with your insurance if you are planning to do med managemnet though this physician. Just a thought.

    HTH
    We currently have a psych NP who manages his meds, but she and I both think that there is something else going on so she had suggested a complete evaluation.

    Hopefully we will just see the develop pedi for the eval and maybe 1x per year for follow-up if that is even standard.

    Thanks for replying.
    Last edited by ArizonaGirl; 03-18-2014 at 12:09 AM.
    Lindsey

    Married to DH June 2005 gave birth to Shawn December 2008 and Lilian August 2012




  5. #5
    ArizonaGirl is offline Platinum level (1000+ posts)
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    Quote Originally Posted by Gena View Post
    DS has been going to a Dev Ped since he was 2.5 years old for autism and other disabilities. She basically acts as his medical case manager.

    During the initial evaluation process (which took nearly 6 months), the Dev Ped ordered some of the tests and gave referrals to other specialists for other tests. She ordered the initial blood work, which included genetic testing, metabolic testing, and checking some of his vitamin levels. She gave us referrals to neurology for an EEG, audiology for hearing testing, and psychology for the ADOS test (Autism Diagnostic Observation Scale). She gave us paperwork to complete that included medical social history and the GARS test (Gilliam Autism Rating Scale). The Dev Ped got all the reports from all the other specialists as well as reports from us and the school. She made the official diagnosis of autism, but closely consulted with other specialists, particularly the psychologist.

    DS sees the Dev Ped once or twice a year. She checks on his progress, his growth and development, and any medical concerns we have. When new issues arise, she orders tests and/or refers us to other specialists. For example she referred us to the geneticist when testing found a chromosome anomaly and ordered an MRI and referral to the neurologist when we discovered DS has face-blindness. She referred DS to the psychiatrist for ADHD symptoms and worked with that doctor to determine the best medicine for DS.

    The Dev Ped does not do IQ testing. When we decided to have that done, it was done by his psychologist.

    We have never had an issue with insurance. The Dev Ped and the other specialists are all at the local children's hospital and are all in network. Scheduling is a problem, however. We were on the waiting list for about 5 months before our first appointment. Even now, we have to schedule appointments several months in advance. It's very frustrating at times.
    I was figuring that scheduling was a problem, but I haven't been able to speak with anyone in the physicians office to schedule an appointment to even see how long the wait is for a new patient appointment.

    I am not in a huge rush and just want to be able to figure out what is going on so that I can help him the best way possible especially since he is to start Kindy in August and I know that in order to get an IEP and many other services through the school the child must have a diagnosis.

    His PsyNP has already formally diagnosed the ADHD, but we just wanted to have a formal eval done to try to get a clear picture of exactly what is going on.

    Thanks for replying
    Lindsey

    Married to DH June 2005 gave birth to Shawn December 2008 and Lilian August 2012




  6. #6
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    Quote Originally Posted by ArizonaGirl View Post
    I am not in a huge rush and just want to be able to figure out what is going on so that I can help him the best way possible especially since he is to start Kindy in August and I know that in order to get an IEP and many other services through the school the child must have a diagnosis.
    I would call the school district now. Schools will look at medical diagnoses, but typically they must do their own testing to see what his disability eligibility is and what IEP services he will need for the school year. Getting that support in place ahead of time will make the start of K so much smoother (e.g. they can have an aide hired/trained/in place for his K room, instead of needing to get one hired quickly a few months into the year and/or using subs.) Is he currently in a preschool program? Do the teachers there have data on what extra help he needs? The needs are not going to change with whatever label your son's issues get, and K will be more demanding.

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