Insurance Matters
Dealing with adult ADHD can be extremely costly, especially if you have inadequate health insurance, don't understand what your insurance plan does and doesn't cover, and aren't aware of the many tax breaks and special assistance programs available to adults with ADHD.
Unfortunately, rising medical costs have led some insurance companies to deny claims, even when they're legitimate. The good news is that many states have established independent review panels and set up regulations that require insurance companies to develop in-house appeal procedures.
Essential
If your insurance company refuses to pay a claim, consider appealing. While fighting a denied claim can be a time-consuming process, studies by the Kaiser Family Foundation showed that 52 percent of patients who appealed won their first appeal, 44 percent won their second appeal, and 45 percent won the third time around.
Although many insurance companies have a limit on how much money they'll pay out per year for treatment for adult ADHD, you may be able to persuade your insurance company to pay a higher percentage of costs by documenting that your need for medical care exceeds what is offered on your policy.
Scoping Out Carriers
If you've been diagnosed recently with adult ADHD, spend some time talking with your insurance carrier to find out what portion of medical expenses you'll be responsible for. If you have a choice of carriers or plans, compare them carefully and select the one that best suits your needs and will save you the most money in the long run.
When reviewing your policy, you'll also want to check if it covers mental health benefits. Find out what types of services it covers and whether it covers outpatient and inpatient care and serious as well as nonserious diagnoses.
Fact
Unfortunately, some insurance companies don't consider adult ADHD a “serious” condition, even though it typically is. To move things along, have your physician send your provider a letter of medical necessity along with test results showing your need for treatment. Remember that insurance companies are huge bureaucracies, so keep meticulous records of who said what, and date every correspondence.
You'll also want to call your insurance company and ask about prerequisites for receiving mental health benefits, the number of visits you're permitted per year, whether multiple services can be scheduled on one day to count as one visit, and what services require pre-authorization and who needs to authorize them.
If your physicians or specialists aren't covered in your plan, you may want to explain your situation ahead of time and ask them if they can either accept your insurance plan, give you the same rate as your insurance plan, or give you discounted health care.
Finally, if the thought of dealing with insurance paperwork and hassles gives you migraines, consider hiring someone who specializes in handling insurance claims for adults with ADHD. It could be an accountant or even a financial coach. Call your local branch of CHADD for suggestions on accountants who work with people with ADHD, ask members of your support group for suggestions, or work with a trained coach who specializes in adult ADHD by contacting the International Coach Federation at (888) 423-3131 or by visiting
Your specialist can file and keep track of claims, follow up on payments and claims discrepancies, negotiate rates with your medical specialists, and ensure you get the best health care for your money.
