When families call our office requesting a comprehensive evaluation of their minor child, it’s almost always because something deeply important is at stake. Maybe a child is struggling with reading, attention, or social-emotional/behavioral functioning, or a medical concern. Maybe there are multiple areas of concern and you’re trying to understand the whole picture. Sometimes the situation is even more complex — such as when there’s a high-conflict divorce, ongoing litigation, or multiple professionals involved who see things differently.
It’s understandable that cost is a major consideration, and I never fault anyone for that. Evaluations are expensive, and many families understandably seek lower-cost or insurance-covered options. I did accept insurance for years, but ultimately, I made the difficult decision to move to a self-pay model because increasing limitations on the number of hours allowed—and what insurers deemed “medically necessary”—made it increasingly difficult to provide the appropriately thorough and thoughtful services I often believed were needed, especially in more complex situations.
What “Comprehensive” Means Here
At Shapiro BrainHealth Group, a comprehensive evaluation is more than a series of tests. It’s a process of understanding how a person thinks, learns, feels, and functions across settings and over time — and how these pieces fit together.
In my world, an evaluation isn’t complete until you are truly on your way. That means the final phase includes individualized recommendations and often consulting with (or vetting) educators and related providers across settings to ensure next steps are clear and realistic. After all, even the most accurate test scores mean little if they don’t translate into meaningful support.
Why Insurance and Lower-Cost Options Often Can’t Cover This
The testing itself is just a snapshot — a single moment in time. The contextualization of that snapshot is what brings it to life. The hours I spend reviewing developmental, medical, and educational records; gathering teacher and provider input; integrating parent and others’ perspectives; and interpreting all of this within the larger picture of brain health and development are what distinguish my evaluations.
This process is especially critical in complex contexts — such as independent educational evaluations (IEEs), high-conflict divorces, or injury-related cases — where the “who,” “how,” and “what” of information gathering can meaningfully influence outcomes. That level of thoroughness takes time, and unfortunately, the number of hours reimbursed by insurance rarely covers both that essential review and the comprehensive testing itself.
What’s more, psychologists are prohibited from “balance billing” — meaning we cannot charge families for the additional hours insurance companies label “excessive” or “not medically necessary,” even when those hours are critical for accurate diagnostic formulation and effective intervention planning. The result? Clinicians must either do less or work far beyond what they’re compensated for. Neither serves families well.
Where Your Investment Goes
When you invest in a comprehensive, self-pay evaluation here, you’re not just paying for test administration. You’re paying for:
- Advanced training and specialized expertise gleaned from doctoral and post-doctoral training that includes advanced work and professional recognition in developmental and sports neuropsychology, health services and school psychology, and behavioral sleep medicine, and in school, clinical, medical, and medico-legal (forensic) contexts, and as a seasoned clinician and trainer.
- Extensive information-gathering. Detailed review of records and data from multiple sources, settings, and over time to fully understand context and patterns.
- Thoughtful test selection. Cherry-picking the best measures from an extensive test library to answers referral questions accurately, efficiently, and meaningfully, bit without unnecessary redundancy or “filler” or the constraints of a narrow list of options.
- Integration and interpretation. Translating numbers into narratives — connecting findings to real-world functioning and tailoring recommendations to the individual, written in plain English and capitalizing on strengths to overcome challenges.
- Comprehensive feedback and planning. More than one brief session and with all who need to be involved, especially the child: clear, individualized recommendations, coordination with educators or other professionals when needed, and guidance about next steps.
The time I devote to this integrative process — before, during, and after testing — is what sets my work apart.
These questions aren’t meant to intimidate anyone — they’re simply ways to ensure that you know what you’re paying for and that it aligns with your needs.
Closing Thoughts: Doing Right by Every Client
I provide evaluations that are appropriately efficient — that avoid unnecessary testing in order to minimize excessive costs but that don’t cut corners, that ask the right questions, integrate information across sources, and apply advanced specialty training to recognize subtle differences or patterns that are easy to overlook yet often clinically meaningful and help to individualize my impressions and recommendations.
My goal is to ensure that your evaluation provides clarity, direction, and confidence — that it answers the “what now?” question fully and compassionately – and in a manner that is customized for your needs.
I am always glad to speak with you — and equally glad to collaborate with other professionals on your behalf. Sometimes it takes a team, or a village, to best serve a child or family. It doesn’t have to be “our way or the highway.” Every brain, child, family, situation, and context is unique.
We welcome opportunities to work collaboratively, to keep learning, and to continue reinventing how we deliver care — all while staying true to our mission: promoting the best evidence-based care, compassionately and collaboratively.
