What is neuropsychology?
Neuropsychology is the study of how the brain's health influences behaviors and abilities that we can see and measure.
Who can perform neuropsychological assessments?
Neuropsychological assessments should be performed only by a clinical psychologist that holds a doctoral degree (PhD or PsyD) and has completed at least two years of neuropsychology residency at the postdoctoral level. Providers that do not meet these requirements may perform other kinds of assessments, but are not qualified to make conclusions about brain-behavior relationships.
What happens in a neuropsychological evaluation?
Your neuropsychological assessment will start with an interview by the neuropsychologist so he or she can learn about you and/or your family's concerns.
The neuropsychologist also asks about your background to better understand your concerns in context. Examples of background information that a neuropsychologist usually asks about include social history, medical history, mental health history, and work history.
The neuropsychologist then gives a series of objective tests that help to measure the brain's abilities that involve listening, answering questions, drawing, or writing. Abilities that are measured include intelligence, attention, memory, language, visual/spatial abilities, executive functions, motor abilities/dexterity, and mood.
Are neuropsychological assessments covered by health insurance?
Neuropsychological evaluations performed on pediatric patients may be covered by insurance companies, though our assessments are considered "out of network."
Neuropsychological assessments performed at STLCCH on adult patients are covered by health insurance if they are considered "medically necessary" by your health insurance carrier. Patients who are referred by their medical doctors for evaluations to assess for things like dementia or ADHD are typically considered "medically necessary." Patients are always encouraged to call their insurance company prior to scheduling to inquire about any cost-sharing obligations they are responsible for that may accompany their plan, such as a deductible, co-insurance, or co-pay.
Neuropsychological evaluations performed for non-healthcare-related reasons like school accommodations, legal proceedings, or work-related issues are not considered "medically necessary," and we require that payment for these services be made out of pocket.
What insurance plans are accepted at STLCCH?
At STLCCH, we accept most major insurance carriers for medically necessary neuropsychological evaluations, including Medicare. Unfortunately, we do not accept Medicaid or any Medicaid replacement plans such as Healthy Blue, Home State Health, or United Healthcare Community plan. We are also unable to accept certain self-funded insurance plans such as National Association of Letter Carriers (NALC).
Why does STLCCH not accept Medicaid or other Medicaid replacement plans?
Neuropsychological assessment is a complex, lengthy, and detailed process that requires the coordination of a neuropsychologist, a clinical staff, and aministrative staff. Unfortunately, Medicaid and its various replacement plans require a convoluted, lengthy, and expensive degree of administrative work to obtain the necessary pre-approvals, and even when this does occur, typically only a small fraction of the required time is approved. Until the Missouri Legislature changes Medicaid rules to permit approval of complete neuropsychological assessments, STLCCH will remain closed to Medicaid and its replacement plans.
Patients and families are encouraged to contact their representatives in the Missouri state legislature to demand that Medicaid and its replacement plans cover neuropsychological assessments in their entirely (https://www.mo.gov/government/legislative-branch/).
What will the results of my neuropsychological evaluation tell me?
The conclusions of your neuropsychological evaluation are tailored to answer the specific referral question that you presented with. For example, if a person is worried about memory loss, neuropsychological evaluation results can help you understand whether memory loss is due to normal aging, dementia, or other non-neurologic factors that can cause memory loss such as fatigue, stress, depression, or pain. If you are your attorney are attempting to discover whether a past head injury is causing current difficulties, results are tailored to answer that specific question.
How long does a neuropsychological evaluation take?
Neuropsychological evaluations at STLCCH typically require about 3-4 hours of time in the clinic, though additional time may be required for certain types of evaluations. The brain is an incredibly sophisticated and complex organ, and a large amount of data needs to be gathered in order to identify consistent patterns that may suggest the presence of some sort of dysfunction. The staff at STLCCH then spend an additional 3-4 hours of time behind the scenes analyzing and interpreting the data that was gathered. It is a detailed and nuanced process!
Why is it important to be assessed by a neuropsychologist? My LPC or LCSW say they can do the evaluation for much cheaper...
Clinical neuropsychology is a specialty within clinical psychology that emphasizes the connection between the health of the brain, and skills and abilities that we can see and measure. The tests that are designed to measure the brain's abilities (like any medical test) all have strengths and weaknesses, and usually a series of many neuropsychological tests are given so that different tests can compensate and cover for eachothers' various strengths and weaknesses. The process required to become familiar with test selection, administration, scoring, and most importantly interpretation is a skill only obtained after a person receives a doctoral degree in clinical psychology, and then continues on for an additional two years in a postdoctoral residency (sometimes called a postdoc or fellowship), specifically designed to teach these skills. There is no single test for any particular disorder, whether it be ADHD, autism, dyslexia, dementia, head trauma, stroke, etc. Diagnosing these conditions depends upon an accurate and complete collection of health history along with the correct combination of tests which vary between individuals, even when people present with the same question.
When LPCs and LCSWs perform psychological or neuropsychological assessments, there are harms that can befall the examinee:
1. Inaccurate diagnosis: When an examinee receives an incorrect diagnosis, it harms patients by delaying treatments that would otherwise address the presenting issue. Sometimes treatments are even delivered that can actually harm a patient based on inaccurate diagnostics. For example, an individual incorrectly diagnosed with ADHD may receive stimulant medication that comes with a high risk of abuse and risking other cardiovascular problems. Additionally, if an examinee receives an incorrect dementia diagnosis, it may cause them to lose automony and privileges such as driving or managing their finances and medical affairs which they should be entitled to. Inaccurate diagnoses can result from incomplete understandings of medical issues affecting cognition, statistical properties of tests, patient characteristics and effort. Neuropsychologists are uniquely equipped to weed through these complexities.
2. Most major insurance carriers as well as school systems, attorneys, doctors, disability agencies, and worker's compensation agencies do not accept diagnoses that are assigned by LPCs and LCSWs, and will not cover these expenses; this leaves examinees stuck with large bills that families are expected to pay even though they did not receive a diagnosis that can help them (and might not even be accurate).
It is important to remember that LPCs and LCSWs serve an incredibly important role in our healthcare system. Providing accessible and timely mental health treatments and interventions and services is a critical component of any healthcare system. However, it is important to be mindful of the differences in expertise and abilities that different disciplines can provide.
