View Full Version : Can I keep ADHD off my medical record while insurance pays for meds??


TangentBoy
06-19-06, 06:27 PM
Hi All,

I'm new here, 32 yo male recently diagnosed, and will post a formal introduction in the right forum but needed some quick advice / experiences. I've been told that sometimes certain conditions such as 'ADHD' could lead to difficulty in obtaining future health/life insurance etc. As such, I have been paying out of pocket for my screening and my psych visits. Someone suggested to me that I might be able to use my insurance (co-pay) for meds without the insurance company being informed about the specific meds due to some pharmacy privacy laws. Does anyone know anything about this??? Or is the only way to keep this off the records paying out of pocket. I appreciate any input and thanks in advance. :)

Nate

Veighen
06-19-06, 07:02 PM
I too want serious advice here. My doctor made my appointment for me.. does that mean it is being paid for automatically? (first appointment to make a diagnoses)

I am very worried about the effect this would have on my record.

Imnapl
06-19-06, 10:53 PM
I too want serious advice here. My doctor made my appointment for me.. does that mean it is being paid for automatically? (first appointment to make a diagnoses)

I am very worried about the effect this would have on my record.Veighen, in B.C., if you are referred to a specialist, provincial medical insurance pays for the visit.

Regarding insurance company paying for meds: my extended medical reimburses me for meds. and has never asked why.

FrazzleDazzle
06-20-06, 12:26 AM
I know a little about billing. In order for an insurance company to pay for a visit, there has to be a diagnosis and a billing code that correlates with the visit. The diagnosis would be, guess what? ADHD, or whatever you are getting having the visit for to get the script, or evaluation or whatever. Otherwise, no insurance moolah comes in. If you are not sure, you can ask the person who does the medical billing at the office where you recieve your services how a visit might be billed, what diagnoses will be on the form, etc. If you have any superbills from paying for yourself, the codes may also be on there, as sometimes folks who pay cash turn them in to insurance themselves, so it would be worth a look at what you already have if your'e in a hurry.

Also, the specific medication will be part of your medical record, and oftentimes the insurance company will ask for your medical records or a letter of medical necessity from the provider to evaluate the claim for payment. This permission is granted by you on one of the forms you first fill out in an office, so please read what you are signing, and ask questions if you are not clear on anything.

Bottom line, keep it cash if you want no one to know. But, future insurance companies do have a right to all of your past medical records to evaluate you for acceptance too, if you go with a company that requires this. They can be very thorough, cash or no cash, your visit is still part of your record.



Here's a really stupid story--I worked for a chiropractor at the time I applied for BCBS. They asked me if I receive adjustments, and I said yes I do as maintenance and a job perk, no injury or anything. They required the records, and they had a waiver on my back, meaning anything that happened to my back they would not cover. :-)

TangentBoy
06-21-06, 06:16 PM
That being said, we all know that the meds are relatively expensive. Especially when you factor in doctor visits to get the right dosage. I would like to hear if anyone has any opinions on the weight of keeping this off the records as opposed to paying for the meds. Can (and do) bad things usually happen insurance wise if you let them pay???

FrazzleDazzle
06-21-06, 09:58 PM
I think it's roulette game, really, one of time, and who is playing the game. You cannot really predict what might happen. Something could untoward happen with any "ding" on your record. Look at what happens when you put in a glass claim on your car, or make a homeowner's claim. Bad things can happen. It all just depends. I honestly don't think it would matter if you put the claim in for your meds or not, because it would still be in your medical record from your physician visit. Unless, you have totally separate coverage for meds than you do for your medical visits? Where one is not involved in any way with the other?

I never really thought about it from your angle, I just do what I need to do, and of course you are going to get a ding anytime you go see a doc, because that's why you go. But then you can get penalized for using the coverage, especially if you get new coverage for some reason. sux. The only time I felt the sting was with the BCBS issue.

This is interesting, anyone else with any other thoughts?

Imnapl
06-22-06, 08:35 PM
Veighen's location is listed as Canada. We have government medical insurance. Extended medical is through private insurance companies.

Matt S.
06-23-06, 10:49 AM
maybe if you are obese you can have a doc say the rx is for that and the only reason I say that is because I take dexedrine and my new insurance gave me a hard time because it is classified as "short term weight loss aid and narcolepsy drug for adults and ADHD drug for a child"

TangentBoy
06-27-06, 12:04 PM
1Kid2Dogs: So far what I've done is that I've seen a different doctor and paid cash for all of the visits related to my ADHD. And the medicine has thus far been paid for out of pocket. My guess is that this record would not be easily found by insurance companies since I didn't use insurance to obtain it (Could be way off here ... lol ). Anyway, I envision that this approach is going to get very expensive very soon..............or I can move to Canada :)

FrazzleDazzle
06-27-06, 11:28 PM
TangentBoy, I don't know how to advise you, but realistically, at some point you may be in the position to be asked to disclose this, and it will be up to you to do so or not. If you will always be covered by employer group insurance, you likely will not have a problem. If or when comes the time you may have to pay for insurance out of your own pocket, OR, if you ever apply for life insurance, you WILL be asked to disclose your past medical history, up to a certain time frame back. This is where you have to decide if you will mention it or not. In these situations, the auditors very thoroughly go over all of your medical records they request from your providers. Really, they are looking for health risks, or waivers they may implement into the policy, or higher rates. It's all about the money, really. They follow up on any leads mentioned in those records, so if your psych provider is even mentioned, or your meds mentioned in any of your other records, it will be followed up on. So 1) If they are mentioned in those records, and you do not disclose it, that's not good. 2) If you don't disclose it, and they don't know, and insure you, but find out somehow later, they may drop you like a hot potato, which leads to the mess in number 3) the next time you apply for any insurance, you will be asked if you have ever been declined, or denied insurance coverage for any reason. And this is where you can get yourself into trouble.

I am the type to just be honest, rather than risk the ramifications of not disclosing something they deem as important and will follow me around for a long long time if I don't.

Hope this helps you better make a decision about how to handle it. Best of luck!

SnappyCloud
06-27-06, 11:49 PM
the pharmacy will have records of the meds you purchased
I guess one could go to a doc, use a false name and pay cash. Fill Rx under that name and pay cash. Then, if you are travelling with your meds and a law enforcement officer questions your possession, the Rx will not match your ID and you'll be in trouble.

I even wonder if the insurance companies, with a release from you, could find these postings here, when investigating you for a life policy, etc.

perhaps it is time for paranoia pill...

TangentBoy
06-28-06, 05:07 PM
1kid2dogs: Yeah, I see what you're saying. I do hope to branch out to self-employment in the future and that's where my concern came in.

SnappyCloud: Using a false name is a bit too much for me. Look at what recently happened to Rush Limbaugh :D

sbgrace777
07-27-06, 11:46 AM
Thanks for addressing this...

Ahh :mad:. Is this a coincidence that the insurance premium shot up? Yesterday I just received a notice that my monthly insurance premium is increasing by $20/month (Blue Cross PPO).

Last week was my 1st visit to a doc in years (rarely have (physical) health issues, so no need to go...so I got the least expensive insurance). I needed to get health insurance last November for my program at school.

I was just diagnosed last week with ADHD combined inattentive when I finally went in to get evaluated. I got a starter kit for Strattera and instructions to get a physical for baseline readings in case need to go to stimulant meds.

'Wish I read this thread last week--better yet, I wish we didn't have to disclose stuff like this out of concern of being discriminated against for having adhd :faint:.

I'm thinking that it isn't coincidence that the premium increased. Your thoughts?:(
Thanks in advance for your input


Hi All,

I'm new here, 32 yo male recently diagnosed, and will post a formal introduction in the right forum but needed some quick advice / experiences. I've been told that sometimes certain conditions such as 'ADHD' could lead to difficulty in obtaining future health/life insurance etc. As such, I have been paying out of pocket for my screening and my psych visits. Someone suggested to me that I might be able to use my insurance (co-pay) for meds without the insurance company being informed about the specific meds due to some pharmacy privacy laws. Does anyone know anything about this??? Or is the only way to keep this off the records paying out of pocket. I appreciate any input and thanks in advance. :)

Nate

TangentBoy
07-28-06, 02:26 AM
Maybe!! Best way to find out would probably be to give them a call and ask why your monthly went up. I bit the bullet and put mine on my insurance. If you're employed in a company you usually pay the group rate, so you don't get screwed.... But I'm no expert in this arena which is why I even asked this question to begin with......Good Luck.

jdawg
07-31-06, 06:19 PM
I'll throw in some experience here. I recently left my last job, at which I was covered by the employer's group plan.

The entirety of my medical visits in the last ten years consists of approximately four doctor visits, one of them a routine physical this year. I had a minor infection in April, successfully treated with antibiotics for 14 days. (No, not due to 'incautious' behavior on my part. :-)

I applied for individual BCBS insurance and was declined because of the recent infection. I must be "free of signs, symptoms or treatment" for "three to six months" before they will insure me.

Prior to applying, I called and asked for the underwriting criteria regarding ADHD. They said the applicant must be "stable on the medication" for twelve months to be insurable. That is why I have avoided an "official" or "on-the-record" diagnosis, until I am covered under the new plan.

Now, this brings up a question along the lines of Tangent's. It is possible to be diagnosed privately, and be prescribed second-line medications available from Canadian pharmacies, for example. In this way one avoids any paper trail available to U.S. insurance companies. But, can someone confirm whether, for example, an insurance company can open the books at a U.S. pharmacy and see what prescriptions have been filled? I'm thinking particularly of the stimulants, which carry a greater paper trail than other meds. (And I'm setting aside for the moment the question of whether or not to disclose - just wondering what they can "find" whether I disclose or not.) Any records/pharmacy experts here?

Imnapl
08-01-06, 09:44 PM
I am sure B.C. isn't the only province in Canada to remove the carbon copied prescription paper trail for the stimulant, Methylphenidate. Ritalin is now just a regular prescription.