ADHD (attention deficit hyperactivity disorder) is a mental health condition that can not only be expensive, but can have life-long effects on one’s job prospects and quality of life. The primary symptom of this disorder, a severe inability to focus, is thought by many to be a mere inconvenience, but this is not the case. Unfortunately, many health insurance companies do not provide coverage for this condition because they do not consider Attention-Deficit Hyperactivity Disorder a serious mental illness. However, this does not mean that parents should have to shoulder the full burden of treatment. Health insurance can cover costs, but parents should be prepared to do some research and appeal denied claims if necessary.
The first step is research insurance policies and state law extensive. Start by looking at the insurance policy itself. If covered, ADHD would fall under the mental health benefits category. Parents should make sure that their insurance policy covers both serious and so-called “non-serious” mental illnesses as well as inpatient and outpatient coverage. Parents should also see how state law applies to their situation. Does the state require full or partial coverage for mental illnesses? Does coverage only apply to severe mental health problems? What is included in the serious mental illnesses category? Answer all these questions before continuing.
Next, call the insurance company and speak with them directly. Are there any pre-requisites for coverage? Some health plans require children with ADHD to seek treatment for as long as a year before they can receive health insurance coverage. Find out how many doctor’s visits are covered per year, as well as which services will need to be pre-certified. It might also be a good idea to ask for a case manager. Establishing a good relationship with your case manager will help if your child’s claims ever get denied.
Make sure to keep a record of everything you do during this process, as well as comprehensive information from your child’s doctor. Insurance companies may ask for the actual test results and/or diagnosis to make a final decision. Remember, even if they deny coverage, you can still appeal. Having a written record of your child’s treatment and your dealings with the insurance company will help you get through the appeal process. Finally, if you cannot get coverage for your child’s ADHD through normal means, you may be able to get coverage through Medicaid if you qualify. Treating a child with this disorder can be expensive, so do not give up no matter what!
If you need assistance in locating particular coverages at a pre-determined price, we can help you save up to 50% on your health insurance monthly premium.