But before you get tested for ADHD, you might be wondering how much it will cost. In many cases, ADHD testing is covered by health insurance. But how can you figure out whether your policy includes that coverage? Read on to learn all about how to determine whether ADHD testing is covered by insurance.
The Costs of ADHD
Insurance coverage for ADHD testing and treatment is critical. The costs of these necessities are often higher than what many patients anticipate. According to a review of published studies, the annual cost of ADHD is estimated to range from $12,005 to $17,458 for children and teens. This includes treatment-related costs as well as other factors like education needs and parental work loss.
The costs are also significant for adults with ADHD, who spend an average of $4,929 to $5,651 per year on healthcare. That's significantly more than the control groups without ADHD, who spent $1,473 to $2,771 per year.
Because the costs of ADHD are so high, getting testing and treatment covered has the potential to be life-changing for many individuals. Without coverage, people with ADHD might avoid getting a diagnosis or taking medication, while those with good coverage can experience improved outcomes from testing and treatment.
Understanding Your Coverage
If you're ready to get tested for ADHD, the first thing you should do is familiarize yourself with your health insurance coverage. Start by taking a look at your policy to see what's covered. Some of the things you'll want to check closely for include:
- Mental health benefits: ADHD is typically categorized by health insurance companies as mental health care, which is now covered by most plans. Look for details on which types of services are included, such as initial assessment and diagnosis.
- Network providers: Depending on the type of insurance plan you have, you may be restricted to in-network providers if you want automatic coverage for ADHD testing.
- Copays: You may have to pay a fixed amount called a copay when you have your ADHD assessment. The copay does not count toward your deductible.
In addition, be aware of what your insurance doesn't cover. Before you undergo any procedures, such as neuropsychological workups or diagnostic brain scans, find out whether they are required to make an accurate diagnosis. In most cases, an evaluation and diagnosis for ADHD does not require these add-ons, and you don't want to get stuck with a bill for something that wasn't truly necessary.
Filing Out-of-Network Claims
Being restricted to ADHD testing within your network can be frustrating, especially if there's an incredibly long wait for an appointment. Fortunately, getting reimbursed after receiving care outside of your network may not be as difficult as you think.
If you've had testing done by an out-of-network provider, follow these steps for the best chances of reimbursement from your health insurance company:
- Collect relevant documents from your ADHD evaluation. This should include any bills you've received and official medical records with your test results. Your clinician and their office administrators should be able to help you collect this information.
- File an out-of-network claim with your insurance company. This can usually be done online through your insurance member portal if you have digital copies of medical records and other relevant documents. It may take up to a month after your claim is submitted to get a response, so be patient.
- If your claim is rejected, file an appeal. It's definitely worth the effort if you get to this step. In fact, one study found that over half of patients won their first appeal, and 44% of those who appealed a second time won. Most states have independent review boards which can help.
Talking to Your Insurance Company
Are you struggling to get health insurance coverage for your ADHD testing and treatment? It's a good idea to try contacting the company directly if you haven't had any luck figuring out your policy, submitting out-of-network claims, or trying to handle things online.
Talking to your insurance company can be intimidating if you've had trouble with getting coverage for ADHD care. The following tips may help you in discussing this matter with your insurance provider:
- Get a referral from your primary care physician.
- Have your clinician highlight relevant medical issues in your referral form.
- Find out if you need preauthorization for coverage before getting tested for ADHD.
At Done, appointments for ADHD consultations are affordable at just $199, and many of our patients have received reimbursement through their health insurance providers. Contact us to learn more about our services, or start with a free online assessment that can be completed in just a few minutes.