I have suspected for a long time that I may have add. I finally decided to do something about it. My insurance does not require a referal but I called my doctor anyway because I thought it would be better than just randomly picking a name out of the phone book. My doctor refered me to a neurologist, this was done over the phone through the nurse, I did not even speak with my doctor. I went to see the neurologist today and we barely even discussed my symptoms, he seemed more interested in my sleep paterns and mentioned the possibility of sleep apnea and gave me the whole speech about ADD going undiagnosed in many but also being overdiagnosed. The whole examination lasted about 10 minutes and included him checking my blood pressure and my reflexes and making me follow his finger and shining the light in my eyes etc....but add was barely even mentioned. He ended up just refering me to a psychologist for neuropsychological testing. His nurse warned me to double check to make sure my insurance would cover the testing, this is what I found:

CIGNA HealthCare does not cover neuropsychological testing for ANY of the following because
such testing is considered educational in nature and not medically necessary. Services that are
considered primarily educational or training in nature or related to improving academic or work
performance are not covered under most CIGNA HealthCare benefit plans (this list may not be allinclusive):

•
attention-deficit/hyperactivity disorder (ADHD)
•

developmental disability, developmental delay
•

learning disability
•

mental retardation
•

Tourette's syndrome
•

when performed primarily for educational purposes
• when performed in association with vocational counseling or training

So I called the doctor that he refered me to to see how much the testing costs and it is $300 for the consultation plus $250 per hour for the test which can last 4 to 6 hours. Grand total could be $1800. After speaking to the neurologist, I get the impression that he does not think I have add, but it did not seem like we spent enough time together that he could even form an opinion. I would hate to spend $1800 to be told I dont have add. Shoul I be taking a different approach? Would a psychaitrist or someone with more experience pecific to add be able to do a diagnosis or at least rule add out without me spending $1800 out of pocket?

And why would he recomend testing that is not necessary?

Hmmmmm, play the insurance game if you must. Make a call to the doctor's billing office and ask them about billing Cigna for the testing for what you were referred in for: sleep apnea. Wink, wink. While there, they will also look for lots of other non-and medically-inclined issues NOT on that list. So, you can possibly have your eval and get ADHD diagnosis on the side, but not as a primary. For example, they might look for anxiety or depressive disorders, which would fall outside that list. See? But do make that call first.

Do fight for the evaluation, it's just the greatest way to get a full diagnosis and recommendations for treatment, developing coping skills, and learning about your strengths and weaknesses.

You may want to check to see what your mental health benefits are. Talking to the insurance company and asking who they participate with who could do the testing may help to solve the problem.

I have been fortunate that the insurance company has paid for a diagnosis and a "second opinion". Sometimes it is just a matter of who is doing the testing and the types of billing codes they use. That was the case for me. They would not cover just anything any doctor wanted to do however both doctors I saw did different testing so their hands were not truly tied by the insurance company.

You may need to advocate for yourself a little but if you are persistant and work with the insurance company things can work out, atleast they did for me.

Good luck,
Ryan

One would recommend testing if it were profitable, for one.

It annoys me (I toned down the word) that insurance companies want to mainly cover things that will kill you. They disregard the studies and statistics about untreated ADHD. They have the same attitude about tobacco cessation. Rather than pay for treatment for the cause, they pay many times over for the treatment of resultant COPD, cancer, etc.

It was not necessary for myself to go through any elaborate testing. I don't know if that's good or bad -- arguments go both ways. Both of the psychiatrists I've seen have taken the online tests I've done, reviewed them, and just asked a few questions. Then wrote prescriptions. There is a TON of variability out there about how this is handled.

Many insurances will not pay for neuropsychological testing for diagnosis of ADHD because it is not all that useful for the diagnosis of ADHD.

A quote from Russell Barkley:
"All right, if you’re going to do an evaluation, what should a clinician be doing? Some parents come in and they say, well, I went to this particular clinic and he gave my child the TOVA (Test of Variables of Attention) and he said that based on that instrument, which is a computerized continuous performance test for measuring attention span and impulse control, he concluded that my child had AD/HD. Or, I went to this other clinic and they gave him the Gordon CPT or I went to this other clinic and they gave him a huge neuropsychological test battery and said that the child has AD/HD. Is that a good evaluation? The answer to all three questions is no. None of those tests are useful for the diagnosis of AD/HD, not in a clinical sense, because they’re not very accurate."
http://www.greatschools.net/pdfs/2200_7-barktran.pdf?date=4-12-05 page 8

This is considered to be the current thinking in the field. The recommended protocol used in the diagnosis of ADHD consists of:
1.Parent and home surveys specifically designed for the diagnosis of ADHD
2.Diagnostic interview on the DSM-IV criteria
3. Clinical observation of the child.
That is it. Currently there are no tests considered valid for the diagnosis of ADHD period.

For those interested this is the diagnostic protocol advised by American Academy of Pediatrics. http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b105/5/1158

Other testing can be useful however and often a full psychological profile is recommenced to get other information and look at comorbid conditions. While useful, this is not required for the establishment of a diagnosis of ADHD.

On the question of a Neurologist referring to a Neuropsych, Most Neurologists work closely with a Neuropsychologist for evaluations and likely the Neurologist simply sent you to someone he trusted. Not all docs are all that aware of costs and insurance requirements.

I am a believer in Neuropsych evaluations as I have worked with some and like the data that comes out. It is just not appropriate, however, for a simple diagnosis of ADHD.

As a note: Some Psychiatrists, after seeing a few thousand cases of ADHD, will shortcut this and simply use the interview alone. I won't comment on this as right or wrong but simply report on what I have often seen.

The questions are very good and I hope this is of some help.

Dizfriz

This is considered to be the current thinking in the field. The recommended protocol used in the diagnosis of ADHD consists of:
1.Parent and home surveys specifically designed for the diagnosis of ADHD
2.Diagnostic interview on the DSM-IV criteria
3. Clinical observation of the child.
That is it. Currently there are no tests considered valid for the diagnosis of ADHD period.

Part of this has to be a case history. Someone with bipolar could look adhd if you only examined who they were in a small window of time. So you want to go back and see that they have always been this way, with no time periods were they were totally normal.

Part of this has to be a case history. Someone with bipolar could look adhd if you only examined who they were in a small window of time. So you want to go back and see that they have always been this way, with no time periods were they were totally normal.

Good comment. I normally consider case history to be an integral part of the diagnostic interview. This would include family as well as individual history.

I should perhaps make a point of showing case history as part of the diagnostic interview when discussing the procedure for diagnosing ADHD. Let me think on this a bit.

Thanks,

Dizfriz

Depending on the type of testing, "neuropsych" testing doesn't necessarily have to be done. ADHD is a NEUROLOGICAL brain dysfunction. 742.9 (Congenital Encephalopathy) can be used as a primary diagnosis, your insurance would therefore process any claims under your medical policy. The ADHD diagnosis is used as a secondary diagnosis. Most major insurance companies only take into account the primary diagnosis on a claim. There is a billing code for developmental testing, that could be used along with an evaluation and management code (office visit). You should call around in your city for a developmental pediatrician. You don't have to necessarily go the mental health route.