So before my diagnosis i was told that, based on my income, the sliding fee could be as cheap as 15$ an hour. Then they sent me a bill for almost 500$ and a week later a denial of health services claiming i didn't fit into crg 1, 2 or 3. (detailed below)

So, does this mean that add/adhd is just not considered a "severe" mental disorder in general, and they were untruthful with me upfront.
OR
Does this mean that my particular diagnosis was just not classified as severe enough?

Has anyone had a similar experience and know how this works?

CRG (Clinically Related Group) – Defining and classifying consumers 18 years or older into clinically
related groups involves diagnosis, the severity of functional impairment, the duration of severe functional
impairment, and the need for services to prevent relapse. Based on these criteria, there are five clinically
related groups:
Group 1 - Persons with Severe and Persistent Mental Illness (SPMI)
Group 2 - Persons with Severe Mental Illness (SMI)
Group 3 - Persons who were Formerly Severely Impaired and need services to prevent relapse
Group 4 - Persons with Mild or Moderate Mental Disorder
Group 5 - Persons who are not in Clinically Related Groups 1 – 4 as a result of their diagnosis being
substance use disorder, developmental disorder, or V-codes

wow i dont even know what to say about this....

well i believe ADD is a pretty severe and persistent mental illness

ever talk to a lawyer?

ever talk to a lawyer?Well, i mean, i just got this a few hours ago. First thought was appeals then small claims suit. I'll post over at big-boards law forum as soon as i talk to the doc, just wanted to see if anyone else had anything similar and if they knew what their add was classified as on paper.

Help for ADD (http://www.help4adhd.org/en/treatment/guides/WWK9S)

What is AD/HD?

AD/HD is a mental disorder, a disorder of the brain. It runs in some families, so it may be inherited. It is a disorder that can last a lifetime, and anyone can have it.


You must have serious symptoms in two areas of your life-such as at work and at home-to be diagnosed with AD/HD. If you have a number of symptoms, but none are serious, you won't be diagnosed with this illness. For example, do the symptoms make it difficult for you to do your job, keep you from completing schoolwork or cause problems in your relationships?
***End Quote

So according to this I would think if you were diagnosed with ADD then you have some problems that are disabling in two areas of your life.

I would ask them to explain their financial responsibility evaluation process, most of these things have a right to appeal final decisions. Often with public mental health systems one has to raise hell.

answers.com/medical encyclopedia (http://www.answers.com/topic/attention-deficit-hyperactivity-disorder?cat=health)

Psychologists and other mental health professionals typically use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as a guideline for determining the presence of ADHD. For a diagnosis of ADHD, DSM-IV requires the presence of at least six of the following symptoms of inattention, or six or more symptoms of hyperactivity and impulsivity combined:
***End Quote



answer.com (http://www.answers.com/topic/adult-attention-deficit-disorder)

Adult attention deficit disorder (AADD) is a term commonly used to describe the neurological disorder attention-deficit hyperactivity disorder For both(ADHD)"Attention Dificit Hyperactivity Disorder" and (ADD) "attention deficit disorder" when the conditions present in adulthood, follow the same diagnostic criteria.
***End Quote

Apparently in children it is considered a developemntal disorder however in adults it is listed as a nuerobiological disorder. I have scanned several resources and this seems to be prevlent in most of them.

Has anyone had a similar experience and know how this works?

CRG (Clinically Related Group) – Defining and classifying consumers 18 years or older into clinically
related groups involves diagnosis, the severity of functional impairment, the duration of severe functional
impairment, and the need for services to prevent relapse. Based on these criteria, there are five clinically
related groups:
Group 1 - Persons with Severe and Persistent Mental Illness (SPMI)
Group 2 - Persons with Severe Mental Illness (SMI)
Group 3 - Persons who were Formerly Severely Impaired and need services to prevent relapse
Group 4 - Persons with Mild or Moderate Mental Disorder
Group 5 - Persons who are not in Clinically Related Groups 1 – 4 as a result of their diagnosis being
substance use disorder, developmental disorder, or V-codes


Looking at this, the key here is to look at group #5:

Group 5 - Persons who are not in Clinically Related Groups 1 – 4 as a result of their diagnosis being
substance use disorder, developmental disorder, or V-codes

This basically states that any sort of developmental disorder (not exactly sure what they mean here, but I would think PDD (pervasive developmental disorders) and LD's would definitely be included here... might also include ADHD since it's a developmentally-occurring disorder).

If it's not group 5, then I would think ADHD is in group 4. I think when they state a severe mental illness, they're not looking at the severity of the diagnosis, but the diagnosis itself. ADHD would be considered less severe, then say, Bipolar disorder (especially Bipolar I) or Schizophrenia. So I think the key here is that they are not covering you because they don't think ADHD is a significant mental disorder.

Thats the first assumption i went with. Which would also mean they should have been up front with me about benefits not being available for any sort of adhd diagnosis.

Thats the first assumption i went with. Which would also mean they should have been up front with me about benefits not being available for any sort of adhd diagnosis.

I agree.... that was pretty "tricky" of them...

I agree.... that was pretty "tricky" of them...After thinking more about it, I dont see any reason they would want to mess with me like this. I remembered that they said they were waiting for my mother to mail back a parental review on my childhood habits, which she eventually did.

I think they key word is eventually. Maybe, their processing department for the insurance was just quicker than the diagnosis. Im not sure how these things work or if Im even on the right track. Hopefully. [more monday I guess]