ADHD: Is It Covered By My Insurance?
In the United States, those suffering with mental health issues often find themselves facing the dual struggle of explaining their illness while having to seek treatment. Attention Deficit Hyperactivity Disorder (ADHD) is one such condition.
Previously called Attention Deficit Disorder (ADD), ADHD is only recently being looked at as a serious condition. This is reflected in patients’ efforts to find medical insurance providers to help pay for treatment and medications for themselves or their children. It can be difficult to know where to look, and who can provide help, when diagnosed with ADHD.
What Is ADHD?
The National Institute of Mental Health defines ADHD as “a disorder that makes it difficult for a person to pay attention and control impulsive behaviors. He or she may also be restless and almost constantly active.”
ADHD does not currently have a cure, and can persist into or remain undiagnosed until adulthood. This disorder can lead to poor performance in school, which can in turn lead to a student dropping out. People dealing with ADHD can also have a hard time maintaining a regular job, which can impact them economically.
Researchers studying ADHD aren’t fully certain of the disorder’s cause. There are a few key contenders for what the cause may be, including:
- smoking, alcohol use, or drug use during pregnancy
- exposure to environmental toxins like lead at a young age
- low birth weight
- brain injuries
Whatever the cause treatments help people learn to live with ADHD. It’s finding a provider who specializes in those treatments, that can be a problem for people with ADHD.
Options for Treatment
The nonprofit ADHD advocacy organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) lays out several avenues people can pursue to find treatment on their website, and we’ll briefly go through them here.
A very common challenge among those with ADHD is trouble paying for medications. Bills for medication and therapy sessions can build up to an overwhelming sum. Especially if someone doesn’t have health insurance to help them cover it.
Luckily, there are assistance programs available to cover some of the cost, depending on the financial needs.
Almost every state in the U.S. as of 2019 has some form of assistance for covering the costs of medications. The National Conference of State Legislatures has compiled an online chart showing each state and what resources are available, as well as explanations of the benefits programs involved.
Some pharmaceutical companies themselves offer assistance programs. These offerings can vary to anything from a medication assistance program, to a discount card providing savings on specific medications. These programs are usually nonprofits, funded by donations, private foundations, and corporate sponsorships, and they include:
- NeedyMeds.org: Their tagline is “Find help with the cost of medicine,” and they’re a nonprofit dedicated to helping people keep down the costs of their medication. A ticker on their website counts over 73 million visitors since 1997. They have sections to connect patients with resources, advocates, and needed services.
- RxAssist: This site serves as a database connecting healthcare professionals and patients with resources, billing themselves as “the web’s most current and comprehensive directory of patient assistance programs.” According to CHADD, they are a national program created by Volunteers in Health.
- Partnership for Prescription Assistance: Sponsored by American pharmaceutical research companies, this free service connects patients with resources providing free or low cost medication.
Which method of treatment you pursue depends on the person and the severity of their condition, but a study put out by the CDC in 2016 recommends parents of young children with ADHD focus on behavioral therapy before they consider medication. In the key points section, the study states:
“Behavior therapy in the form of “parent training in behavior therapy” is the recommended first-line treatment for young children with ADHD. It works as well as medication without the risk of side effects. The American Academy of Pediatrics recommends health care providers advise parents of young children with ADHD to obtain training in behavior therapy and practice that before trying medication.”
Some states’ Medicaid programs won’t pay for therapy sessions which involve the parents of a child with ADHD, for example. Some states like Louisiana provide managed care plans which cover most or all of the cost of treatment, but medical professionals certified to provide therapy are in short supply, so doctors prescribe medication more often.
Healthcare providers will usually have search tools on their website to help you find doctors or specialists in your area. ADHD falls under the category of mental health benefits, so if your coverage includes that category, you should be able to find treatment. Certain healthcare providers like HMOs will require pre-authorization for treatment. When looking for a specialist, it’s important to know your rights, as well. Since 2008, it has been illegal for group health plans to make mental health care more expensive. Discrimination against people with mental disorders by insurance companies has been illegal since 2010. If you’re unsure where your state stands on mental health, you can review a list of the mental health parity laws by state online.
If you cannot find a specialist, your insurance provider might be able to connect you with someone out-of-network. Community clinics are also an option, but can have lengthy waiting lists. Another route suggested by Clinical Psychologist Mary C. Lamia in an interview with WebMD is to find independent graduate schools where student therapists study.
Awareness of mental health issues as a whole in the U.S. have been on the rise. Talk to your provider, your doctor, and if you’re seeking treatment for your child, to your pediatrician. They will likely be able to provide the necessary referrals to a specialist for you.