ADHD: Is It Covered By My Health Insurance?

In the United States, those who have a mental illness often find themselves seeking treatment for something others can't immediately see. Attention Deficit Hyperactivity Disorder (ADHD) is one such condition. 

Patients' efforts to find health insurance providers to help pay for treatment and medications for themselves or their children are increasing. When receiving an ADHD diagnosis, it can be challenging to know who can provide help and where to look for it.

A 2016 survey asked individuals who have a health insurance policy that includes coverage for ADHD about their experience. Over half of those individuals reported having trouble accessing services to diagnose and treat ADHD.

If you or a loved one received an ADHD diagnosis, here are two things that are important to understand:

• A brief definition of ADHD and any possible risk factors

• Treatment options available and the common issues when navigating treatment costs and the healthcare system

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. Most people who think of ADHD probably think of an overactive kid who can't sit still. While this is undoubtedly one of many symptoms, this disorder can have real negative impacts on the individual's life.

ADHD can affect a child's performance in school, resulting in the student progressing slowly, dropping out, not graduating, etc. People dealing with ADHD into adulthood may also have a hard time maintaining a regular job, putting stress on their financial stability.

Researchers currently studying ADHD aren't entirely sure of the disorder's cause, but there are a few critical contenders for certain risk factors, including:

• genetics

• smoking, alcohol use, or drug use during pregnancy

• exposure to environmental toxins like lead at a young age

• premature birth

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. Medications and behavioral therapy are the two primary options.

Medications

Stimulant drugs (psychostimulants) are currently the most commonly prescribed medications for treating ADHD symptoms. These medications work to balance neurotransmitters, helping improve symptoms of inattention and hyperactivity.

A common challenge among those with ADHD is trouble paying for these medications. As the condition is a chronic one requiring ongoing treatment, bills for medicine, and therapy sessions can be costly.

While many health insurance companies do offer coverage for ADHD medications, some require a prescription from a psychiatrist. Often you will need a referral to see a psychiatrist, so it's important to check with your health insurance plan on their policies for coverage.

However, if you don't have adequate health insurance coverage for these treatments, the costs can be overwhelming. There are assistance programs to supplement the price, depending on your 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 compiled an online chart showing what resources are available, as well as explanations of the benefits programs involved. 

Some pharmaceutical companies themselves offer assistance programs. These offerings can vary from a medication assistance program in which the company covers part of the cost to a discount card, which provides savings on specific medications.

Behavioral Therapy

Which method of treatment you pursue is a personal choice and depends on the severity of the condition. However, a study put out by the CDC in 2016 recommends parents of young children with ADHD focus on behavioral therapy before they consider medication, when possible. 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.

This can be easier said than done, as parents have to find a provider that their insurance covers. ADHD treatment varies by state, so those seeking treatment should check with their provider to see what services their insurance will cover.

Some states' Medicaid programs won't pay for therapy sessions that involve the parents of a child with ADHD, for example. Some states, such as Louisiana, provide managed care plans which cover most or all of the cost of treatment. However, medical professionals certified to provide therapy are in short supply, often leading to doctors prescribing medication more frequently. 

Health insurance providers have search tools on their websites 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 through them. Keep in mind that specific health insurance plans, like HMOs, will require a referral/pre-authorization for treatment. 

When looking for a specialist, it's essential to know your rights, as well. Since 2008, it has been illegal for group health plans to make mental health care more expensive than other kinds of health care. Also, 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 or have minimal options, your insurance provider might be able to connect you with someone out-of-network, but you would likely have to pay out of pocket for those expenses. Community clinics are also a convenient option but know they can have lengthy waiting lists. 

Another route, suggested by Clinical Psychologist Mary C. Lamia, is to find independent graduate schools where student therapists study. These students are required to log hours of practice while undergoing licensing to provide therapy and may be able to help with treatment.

Recap

While there can be some hurdles when seeking treatment for conditions like ADHD, awareness of mental health issues as a whole in the U.S. has been on the rise. States have been increasing medical professionals qualified to provide therapy, and grant-funded programs are offering incentives for more professionals to specialize in mental health treatment. 

It's always important to first 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, or at the least point you in the direction of useful resources.