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Expert Q&A

What do you do if your insurance company will not pay for a test related to a disability?

My son has been tested and diagnosed with CAPD. However, the doctor who did the testing tells us the report she completes with the information as to what needs to be done for my son is a separate cost of $400. My insurance company will not pay for it. I have verified with my insurance company that they will not pay for it because it was not included in the overall testing cost. How can a doctor do testing and charge for the report in such a manner that it is not covered by insurance?

Any advice you can give me would be appreciated! Thank you!


Dear Deb,

You should review your insurance policy and benefits book to make sure that the insurance company’s interpretation is correct. You may consider appealing their position to your state insurance commission. On the other hand, if your doctor did not inform you of the extra charge for the report, you may also have a legitimate complaint with them, particularly if they were aware that the results would be needed by the school district. This could be pursued through the state licensing agency or the clinician’s professional association.

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