View Full Version : Just diagnosed with severe ADHD - the cost of treatment is overwhelming


Texas05
03-29-17, 11:05 AM
Hello all-

Newbie here! I've been seeing an in-network psychiatrist for about a year now for ADHD treatment and I've had no improvement in my life. The meds aren't doing anything and, in fact, things have gotten worse and I've hit a wall professionally and personally (more details below). My psychiatrist also doesn't seem to be invested in my care at all, even though my livelihood has been at stake for a while (again, see below). I recently asked my doc for a referral to a specialist and he referred me to the ADHD center at Mount Sinai, which is out of network for me. After an initial $400 intake session, the therapist there diagnosed me with severe ADHD (the combination type) and signed me up to do an ADHD group that runs for 12 weeks. The total cost of this is $1,800, due upfront. Additionally, I just had my first session with the psychiatrist who heads the ADHD department at Mount Sinai, who is very $$ and very out-of-my-network (Dr. Newcorn at Mount Sinai - any thoughts?). And even he said that he was stumped as to why the medicine wasn't working but said he was "up for the challenge." Obviously, I'm going to be a difficult case to treat and, with my schedule, it's tough for me to shop around. I'm also at the point where I just want something that WORKS, but I may be unemployed soon, so cost could become as issue. So my questions are as follows:

1. Is it to be expected that most of the really good ADHD specialists don't accept insurance?

2. Are these out-of-network specialists worth it or is it fairly easy to find a good psychiatrist/ADHD coach/cognitive behavioral therapist that accepts most insurance? I have Oxford, by the way.

3. Where do I even start looking for a good therapist/psychiatrist? Even if I just start going to different doctors to "shop around", only time will tell whether they are actually effective. I just don't want to waste another year of my life trusting a doctor who has no clue what he/she is doing.

[...edited to remove material duplicated in another thread... -namazu]

Throughout all this, I've had been taking ADHD medication and seeing my psychiatrist monthly to adjust the dosage, but nothing seems to be working. During fast-paced "deals," I'm able to bill excellent hours, but for the run-of-the-mill general corporate maintenance, I JUST CAN'T. I'm terrified of losing my job because I'm still at the stage where grades really matter to potential employers. I'm stressed all the time and the cracks are really starting to show. I need help - I just can't go on like this.

Thank you all in advance for any advice.

Texas05
03-29-17, 11:48 AM
I tried to edit the previous post to make it shorter, but it seems I can't. Sorry, everyone, for the crazy long post!!

sarahsweets
03-29-17, 03:21 PM
Hello all-

Newbie here! I've been seeing an in-network psychiatrist for about a year now for ADHD treatment and I've had no improvement in my life. The meds aren't doing anything and, in fact, things have gotten worse and I've hit a wall professionally and personally (more details below). My psychiatrist also doesn't seem to be invested in my care at all, even though my livelihood has been at stake for a while (again, see below). I recently asked my doc for a referral to a specialist and he referred me to the ADHD center at Mount Sinai, which is out of network for me. After an initial $400 intake session, the therapist there diagnosed me with severe ADHD (the combination type) and signed me up to do an ADHD group that runs for 12 weeks. The total cost of this is $1,800, due upfront.
I have some concerns although I may be overthinking things. Lets assume understands insurance well enough to know that you chose him because he was covered. And lets assume hes been around long enough to have a halfway decent network of colleagues. And, lets assume he knows you will be self pay. WHY would he send you to Mt Sinai to THE most expensive specialist? I get it that he wants you to see a specialist- but this isnt like you havent been diagnosed or tried meds, its not your first time. He has already done the footwork. You would probably be self pay for a specialist but 1800$$?? And you have to pay BEFORE you get the services? Something just doesnt sit right about it.


Additionally, I just had my first session with the psychiatrist who heads the ADHD department at Mount Sinai, who is very $$ and very out-of-my-network (Dr. Newcorn at Mount Sinai - any thoughts?). And even he said that he was stumped as to why the medicine wasn't working but said he was "up for the challenge."
At those prices, I bet he is!


1. Is it to be expected that most of the really good ADHD specialists don't accept insurance?


I think its because of the reimbursement rates. While I dont know the specifics, I can imagine that they do not get anywhere near their billable rate. Insurance companies negotiate fees with different providers. Providers that take certain insurances accept that but need to take on more patients to make up for not getting their regular fees. More patients=less time per patient=not as thorough and/or willing to do much trial and error. Maybe you just didnt seem profitable enough or maybe he really wants a second opinion, but he could have considered other specialists.


2. Are these out-of-network specialists worth it or is it fairly easy to find a good psychiatrist/ADHD coach/cognitive behavioral therapist that accepts most insurance? I have Oxford, by the way.

What is this specialist supposed to do for you at 1800$? There is no way to guarantee any sort of results and thats a huge amount of money to put out ahead of time.

3. Where do I even start looking for a good therapist/psychiatrist? Even if I just start going to different doctors to "shop around", only time will tell whether they are actually effective. I just don't want to waste another year of my life trusting a doctor who has no clue what he/she is doing.

Google is your friend, along with your insurance network referrals. Anytime you get a name, call them to confirm and look up reviews, This way you wont be going into things blindly.

Texas05
03-29-17, 03:33 PM
Thank you for your response! To clarify, there's one therapist/psychiatrist that run the group session (at Mount Sinai) and then there's another psychiatrist at Mount Sinai that is working with me on my medicine. His rate was $600 for the initial consultation, then $400 going forward.

Not sure why my doc referred me to someone OON. Maybe I just seemed desperate.

I didn't realize I could get referrals through my insurance! Thanks for that!

ajaxblu
03-29-17, 04:14 PM
I think Sarah has this covered but I thought I'd offer some input as a frame of reference. I just looked up my insurance claims - my initial appointment with my psychiatrist 2-3 months ago was $200 (pre-insurance payment). Subsequent appointments (where we discuss effects of meds and progress) are $75.

I'm in Indiana, though, so of course it'll be less expensive than NYC, but the ratio difference is perhaps pretty high.

Johnny Slick
03-29-17, 04:19 PM
I've been paying $270 out of pocket for sessions with my therapist in Chicago, so yeah, YMM definitely vary.

Texas05
04-04-17, 06:05 PM
Thank you, everyone! I'm working with my insurance and with the Mount Sinai providers now to see what we can do. Stupid Mount Sinai submitted a bill for $1,200 for the first intake session with the therapist when I was initially quoted $400 (as self-pay, I guess), and $1,000 for the initial session with the Mount Sinai therapist (I was quoted $600). I'm really livid right now. This is highway robbery.

Yoshiyama
04-10-17, 12:33 PM
I would def talk with your insurance to see what providers they may have in-network. If they don't have any in-network, they may authorize an out of network claim for you where they would cover whatever they would pay for an in network provider & then you would only have to cover the balance due. That is how Cigna which is the insurance I have works. Or they may work out a deal with Mount Sinai for the services. Again, it is always a good idea to check with your insurance to see what they might be able to do for you. I have managed to get things covered from various companies that were out of network just by calling & explaining things to them. I actually remember having my insurance deny paying a broken ankle claim because I did not pre-autherize it. I called them & asked them, ummm when was I supposed to pre-autherized it as I was brought in by ambulance, drugged up on morphine & in surgery within 5 hours to fix it??? The lady on the other end said I am fixing it right now, & we are paying the claim. It was denied by the system automatically. Learned right then, always call the company on everything!

sarahsweets
04-10-17, 01:20 PM
Thank you, everyone! I'm working with my insurance and with the Mount Sinai providers now to see what we can do. Stupid Mount Sinai submitted a bill for $1,200 for the first intake session with the therapist when I was initially quoted $400 (as self-pay, I guess), and $1,000 for the initial session with the Mount Sinai therapist (I was quoted $600). I'm really livid right now. This is highway robbery.

Do you mean they submitted a bill to your insurance anyway even though you were told you were self pay?

ToneTone
04-10-17, 10:13 PM
Yes out-of-network diagnosis and treatment is ridiculously expensive. But if there is a time to spend money, this is it1

BTW: it is hard to find in-network psychiatrists in a lot of places. In my area just south of you, it is nearly impossible to find a psychiatrist who takes insurance. I found one, who actually Skyped from California to a local office. Interestingly, the reason this guy skypes now is that he sold his local practice around me and moved to California to be with family.

But his patients kept calling him because they couldn't find a replacement psychiatrist (who took insurance) ... So now the guy Skypes on weekends!

I ultimately chose a psychiatrist nurse practitioner, and this woman gives me as much time as my former out-of-network, expensive psychiatrist gave me. She is a great listener, is flexible, is willing to try different meds at different dosages ... it's fun to meet with. I'm happy ... And she is in network. Apparently nurse practitioners don't have the same salary needs as doctors--I don't know.

Hang in there ... Once you hopefully find a good medication combination, then talk to your family doctor and beg them to take over prescribing ... that's one option ... But I would try the psychiatrist first ...

Good luck ...

Tone

Bouncingoffwall
04-11-17, 12:18 AM
If you PM me, I can point you towards some effective self-help resources that are completely free. I wouldnt pay $1800 for concepts you can learn and practice on your own; especially if you're cash-strapped and going to school.

aeon
04-11-17, 10:07 AM
Find a family doctor/general practitioner with a specialty/expertise in ADHD, and its treatment, if possible.

I did (though I wasn’t looking for that at the time), and he diagnosed me (at 41 years of age), and it has meant I have never had to seek out a psychiatrist.

He has also been excellent about medication in terms of being open to try solutions until finding what worked best, process of titration and evaluation, and remaining aware of the out-of-pocket costs I would have to bear for a given prescription.


Cheers,
Ian

Bouncingoffwall
04-11-17, 10:54 AM
OP, depending on the university you're going to, they might have a counseling center you can go to for free as well.

Letching Gray
04-11-17, 07:06 PM
Newbie here!

Hi Texas.

I have a few questions, too.

Who was the therapist who dxd you? Who rxd the meds you took?

She cannot sign you up for anything.

Dr. Newcorn is a child and juvenile psychiatrist.

What tests did she, the therapist, use that defined your ADHD as combined and severe?

Where do you think your major issues with ADHD lie? Which meds and at what dosages were you rxd?

Letching Gray
04-11-17, 07:24 PM
Yes out-of-network diagnosis and treatment is ridiculously expensive. But if there is a time to spend money, this is it

I ultimately chose a psychiatrist nurse practitioner, and this woman gives me as much time as my former out-of-network, expensive psychiatrist gave me. She is a great listener, is flexible, is willing to try different meds at different dosages ... it's fun to meet with. I'm happy ... And she is in network. Apparently nurse practitioners don't have the same salary needs as doctors--I don't know.

Hang in there ... Once you hopefully find a good medication combination, then talk to your family doctor and beg them to take over prescribing ... that's one option ... But I would try the psychiatrist first ...

Good luck ...

Tone


Who is the NP you see, may I ask? Did the doctor who skyped from CA get reimbursed from insurers, do you know? Appointments with doctors through skyping would save a lot of hassle.

ToneTone
04-12-17, 09:44 PM
I don't feel comfortable giving a name of my nurse practitioner ... you can message me in private and I'd be more willing to share ...

But my nurse practitioner's name is irrrelevant ... you need someone near you ....

Yes, the skyping doctor took insurance.

Tone