View Full Version : Can't get an official diagnosis because of insurance


5miraclez
04-19-06, 02:10 PM
Well, I finally got in to see a psychologist. I didn't tell him what I thought the problem was, just told him I was there for depression like I have told so many other therapists. Since I had been diagnosed with OCD, PTSD, depression and bi-polar in the past, he asked about each of those and why I thought they had diagnosed me with those disorders. About half way through talking, I could tell he was beginning to lean toward me having ADD because his questions were more geared toward ADD, like what type of student were you, how is your motivation, and do you feel you are creative or have many ideas? Finally, at the end he told me "I think I'm going to have to give you yet another diagnosis. I think you have inattentive ADD".

A big problem comes up at this point. The diagnosis isn't "official yet" and it can't be. If I get an official diagnosis of ADD, our insurance won't pay for it. It's stupid but they will pay to treat depression but not ADD. So what should I do? I mean, obviously I'm depressed but I think it's caused from the ADD. Should I ask him to not diagnose me? Can I still get treated if they diagnose me with depression knowing that I also have ADD? I'm already having to pay a $300 deductible and can't afford each session to cost me $100. I just don't have it.

Where do I go from here? I hate our insurance and medical insurance in the states in general. Anyone else ever have this problem?

minn306
04-19-06, 02:18 PM
I am so sorry to hear you are going through this. I personally have not heard of an insurance company not paying due to the ADD diagnoses. Do you know why the insurance company will not pay? Can you call them and ask what else are you suppose to do. That is what I would do.

Best of luck to you

chameleon
04-19-06, 02:32 PM
I've never run into a problem with insurance paying for my ADD therapy and meds. I didn't know some insurance companies didn't cover it.
I think you should call your doc, tell him what you told us, and ask him what he suggests.

chloe516
04-19-06, 05:16 PM
I haven't had a problem either. Did you talk to your insurance or your Dr. to see how you might be able to get them to contribute? Sometimes it can be different depending upon whether they list it as a medical or psychological expense.

I hope you are able to get help! I feel the same way you do about the depression being about things related to the ADHD (for me, also OCD).

Tara
04-19-06, 05:23 PM
Have you reported the insurance company to any of major Organizations which support adults with AD/HD?

CHADD (http://www.chadd.org)
ADDA (http://www.add.org)
ADD Resources (http://www.addresources.org)

These insurance companies are just clueless. If they conducted a bit of research they would learn that in the long run it will cost them less to treat Adult AD/HD.

f_wcomboadhd
04-19-06, 07:19 PM
Hey Rebecca,
I'm sorry to hear that your insurance is jacking you like that...I've had a couple of different insurance companies during my current job and I've never received a rejection for diagnosis like that.
I can say this for anyone applying for life insurance in the future. I don't want to ever discourage anyone from getting the mental health care that they need but I was IRATE to discover that the insurance company used my diagnosis of deppression/anxiety disorder and ADHD to increase my premium. Shocked and stunned since my husband is five years older than me and a dedicated full time smoker of 13 + years..and I was in my late twenties at the time sans smoking.
Just sucky!!!

~boots~
04-19-06, 09:01 PM
Can you change insurance compaines without losing your benefits?
At least you are headed along the right track ..good Luck

stanzen
04-20-06, 01:13 AM
I hate our insurance and medical insurance in the states in general. Anyone else ever have this problem?
I agree, been a problem 4ever with healthcare in the US. Now the insurance companies have carte blanch to do what they really want to do: provide health insurance only to healthy people!

Oh, and if you get sick, they do everthing to stop your coverage.

That does not make sense for a rational public health policy.

Lobby our knuckle-head politicians, helps my occassional depression.

As for your provider: ADHD is an Axis I psychiatric diagnosis (like depression) and they should cover this if they cover psychiatric illness and drugs at all. They may tell you they'll only pay for generic drugs like dex or mixed-amphetamine salts or methylphenidate, but, hey you don't need the brand names.

Unless they consider ADHD a pre-existing condition? Now, that would be a bogus loophole.

I would take a look at your policy and call your provider to find out what their stated coverage is. Each state has its own insurance commisioner. You can send a complaint to the commisioner's office, and this works -- at least in Cali.

good luck and keep fighting.

meadd823
04-20-06, 03:59 AM
Where do I go from here? I hate our insurance and medical insurance in the states in general. Anyone else ever have this problem?

Actually no because I do not have health insurance; I pay cash for all my visits and medications. I was insured when I first got diagnosed, which helped. Being stable isn’t quiet as expensive but it still cost plenty!


I think stanzen has some excellent suggestions……I am also curious as to why they don’t cover ADD but do cover depression both brain chemical origins!


As for your provider: ADHD is an Axis I psychiatric diagnosis (like depression) and they should cover this if they cover psychiatric illness and drugs at all.


The insurance coverage maze has become a profession unto it self….doctors often do not diagnosis according to what they really think but according to what the insurance will pay!

Most doctors offices employee people who specialized in how to code the diagnosis portion so that it will be covered…….Medicare and Medicaid are NOT any better.. I have spent time reading off diagnosis to lab billing clerks to see if the code can be used to cover a lab test! It is insane!



Each state has its own insurance commissioner. You can send a complaint to the commissioner’s office, and this works -- at least in Cali.


Utah complaint / legal stuff (http://www.insurance.utah.gov/complaint_Inst.html)

I do wish you luck!

5miraclez
04-20-06, 12:29 PM
Thanks everyone,
This is what we were told by someone who was actually trying to help us. She said I would have to be diagnosed with depression, then they would cover for me to see a psychiatrist but I still have to pay a $300 mental health deductible on top of the $300 medical health deductible and the $60 per month prescription deductible and another $300 deductible for supplies. Oh, but then they will pay 80% after that. It's not like we aren't already paying almost $500 month just to have insurance plus all the copays which are $35 a pop. It's ridiculous. Anyway, they consider ADD to be a medical condition, not a mental health issue so that is why it's not covered. Once I am diagnosed, they will then refer me to the prescription part of our health insurance who will determine what they will pay for and that's it. I know this sounds stupid but I really can't fight it. If I do, they can drop me because I do have prior existing conditions (Type 1 diabetes for 28 years) that we have already had to fight to be covered for. I won't even get into dental insurance. And this is the good plan. You should see what the other plans offered would cover. Funny thing is, that if I were on medicaid, all this would be paid for. What's the point of having insurance if they don't pay for anything. GRrrrr

chloe516
04-20-06, 12:35 PM
Wow, my insurance said that if ADD was considered a medical condition (the person I talked to wasn't sure) that I would just have to get a referral from my primary care. That's too bad they are making it so hard for you.Thanks everyone,
This is what we were told by someone who was actually trying to help us. She said I would have to be diagnosed with depression, then they would cover for me to see a psychiatrist but I still have to pay a $300 mental health deductible on top of the $300 medical health deductible and the $60 per month prescription deductible and another $300 deductible for supplies. Oh, but then they will pay 80% after that. It's not like we aren't already paying almost $500 month just to have insurance plus all the copays which are $35 a pop. It's ridiculous. Anyway, they consider ADD to be a medical condition, not a mental health issue so that is why it's not covered. Once I am diagnosed, they will then refer me to the prescription part of our health insurance who will determine what they will pay for and that's it. I know this sounds stupid but I really can't fight it. If I do, they can drop me because I do have prior existing conditions (Type 1 diabetes for 28 years) that we have already had to fight to be covered for. I won't even get into dental insurance. And this is the good plan. You should see what the other plans offered would cover. Funny thing is, that if I were on medicaid, all this would be paid for. What's the point of having insurance if they don't pay for anything. GRrrrr

DianeS
04-21-06, 12:32 PM
5miracles, to me it sounds like the setup you have is OK. Hang on while I explain how I see it:

1 - You're allowed to see the psychologist. Your insurance has stated that depression is an allowed reason to see him. ***The only thing you and the doc have to think about is the reason he states for seeing you when he BILLS the insurance company for your sessions. If he's willing to put "depression" or some other allowable condition as the reason for seeing you, then you're fine.

2 - You're allowed to be diagnosed with ADHD. When that happens, your health insurance will send you to the prescription department and the prescription people will tell you what medications are allowed and what costs will be covered and not covered.

It's a pain, I agree, but unless I'm missing something important it sounds like you can still do everything you need to do, with a little cooperation from your psychologist. And that kind of cooperation is VERY NORMAL. You wouldn't be asking anything unusual of him.

For instance, my insurance company won't cover any treatment for TMJ, but covers treatment for "jaw pain" just fine - though they're the same treatment. Most doctors decide to put "jaw pain" on the reports without a problem. My insurance company won't cover any treatment for infertility, but covers treatment for "irregular menses" or "menstrual pain" just fine. - although they're the same treatment. Most doctors decide to put "irregular menses" or soemthing like it that the patient is experiencing on the insurance paperwork without a problem.

Anyhow, I hope this makes sense, and I hope I haven't wasted your time by missing something in your earlier explanation. Hope it helps!

5miraclez
04-21-06, 05:46 PM
Thanks again,
I'm sure the psychologist is aware of the problem with our insurance since others are referred to him all the time through the network. I just have to figure out a way to tell him that he has to put treatment down as depression and not ADD. I wonder how that will effect anything if I want to go to group therapy for ADD?

Anyway, I go back in a few weeks and he will then give me an official diagnosis. In the meantime, I'm just reading everything I can and trying to stop blaming myself for everything.

minn306
04-21-06, 05:50 PM
Best of luck to you through all of this and please keep us informed, okay?

chloe516
04-21-06, 07:20 PM
I just fought with my insurance company yesterday. I want to do more in depth testing to go along with my diagnosis. I live near three Hallowell Centers, why not go to the best if they're close, right??

I was told by the Hallowell Center that they do not take insurance, but many people are able to get reimbursed through their insurance company. Not my insurance company! My primary care was willing to refer me to the Hallowell Center and say that they felt I should go there to get the best care, but they knew my insurance company would tell them no, and I would get stuck with the bill. (The insurance company ways tricky and called my primary care three-way to tell them who I should be referred to, so my doctor couldn't even feign ignorance.)

I then thought I would be smart and see if any of the individual doctors at the Hallowell Center were "in-network." One was!!!! But guess what?!?! There are different sub-insurance companies with my carrier and out of 5 mental health networks, mine wasn't one of them!!!!!!:mad: If I lived in a different part of the state, it would have been covered just because of the doctor's name!!!:faint:

I'm going somewhere else, but it is awful to know that there are ways the Hallowell Center would have been covered, just not through my insurance company.:(

5miraclez
04-22-06, 06:14 PM
I live about 30 min from the Hallowell Center at the University of Utah. That was our second line of hope if this psychologist didn't know what he was doing. We'll see how it turns out. Either way, out insrance wouldn't pay for me to go there because the U is out of our network.