Insurance coverage for neuropsychological services varies widely by plan, and many families are surprised by how limited coverage can be. Even when a child's needs are significant, insurance companies apply specific criteria when deciding what services are eligible for coverage.
Many insurance plans do not cover evaluations that are considered primarily educational in purpose. These are evaluations used to understand how a child learns, to guide instructional planning, or to support school-based decisions rather than to direct medical treatment.
Coverage may also be limited or denied based on factors such as the child's diagnosis, the referral reason, the scope of testing requested, or the insurance company's internal criteria for medical necessity. In some cases, insurers may determine that sufficient information already exists to support a diagnosis and deny coverage for further testing, even when additional assessment would be clinically helpful.
Examples of services that are often not covered by insurance include:
- Educationally focused evaluations
- Testing requested primarily for school placement, academic planning, or accommodations such as IEPs or 504 Plans
- Comprehensive evaluations that exceed the insurer's limits on testing time or test selection
- Services the insurer determines are not medically necessary under the terms of the plan
- Follow-up services such as school consultation, extended feedback sessions, or coordination with educators
Even when out-of-network benefits are available, reimbursement is often partial or unavailable. Insurance companies may reimburse only a portion of the total fee, apply reimbursement toward a deductible or out-of-network maximum, or deny coverage entirely. These decisions are made by the insurance carrier and vary by plan.
Families are encouraged to contact their insurance provider directly to understand their specific coverage, limitations, and exclusions prior to initiating services.