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Old 02-17-18, 02:53 AM
theadogg32 theadogg32 is offline
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New doctor requiring re-evaluation?!? too exp.!?! (ADHD since childhood).)

I was diagnosed ADHD in elementary school and have been on & off medication during different periods of my life. I have never had difficulty getting back on stimulant medication by providing my full psychological report from childhood w/test results. I started taking Vyvanse approximately 3 years ago when I began my Master's program and just recently graduated with a 4.0!! My original nurse practitioner left the practice & transferred me to another NP but he is requiring me to be re-evaluated to confirm my ADHD diagnosis within 6 months or he will no longer prescribe my medication. I don't like switching doctors when I already have a relationship with a doctor who is willing to continue prescribing the VyVanse, which works well for me, but this re-evaluation is going to cost me like $2500 because my insurance through the affordable care act forced me to change companies and my current NP is out-of-network. My current NP states this is common "best practice" and that any doctor is going to likely require me to be re-evaluated because my diagnosis is so old, but the NP who saw me for the last 3 years never had any issues prescribing the medication!?!? Is this normal or should I begin searching for a new PCP and how does one go about doing that without being viewed in a negative manner. I understand the current abuse-related problems with stimulant medication. To further complicate the situation I received a job offer w/benefits that would become eligible after 90-days. However, the benefits plan through United Health Care lists Vyvanse as non-formulary (aka they aren't gonna pay for it) has a higher deductable & isn't even as good as the plan I currently have (premiums relatively the same after I lose my ACA tax credits). So many factors to consider: seems cheaper to stick with my current insurance even if I have to pay the $2500 b/c vyvanse costs 260/month vs. $75 w/current insurance. Can anyone help, most especially anyone from the Richmond, VA area?
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Old 02-17-18, 07:13 AM
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Re: New doctor requiring re-evaluation?!? too exp.!?! (ADHD since childhood).)

Quote:
Originally Posted by theadogg32 View Post
I was diagnosed ADHD in elementary school and have been on & off medication during different periods of my life. I have never had difficulty getting back on stimulant medication by providing my full psychological report from childhood w/test results. I started taking Vyvanse approximately 3 years ago when I began my Master's program and just recently graduated with a 4.0!! My original nurse practitioner left the practice & transferred me to another NP but he is requiring me to be re-evaluated to confirm my ADHD diagnosis within 6 months or he will no longer prescribe my medication.
Is this NP associated with a psychiatrist or just a primary doc? You should be seeing a psychiatrist who understands adhd-not a PCP who is now your assigned person who doesnt understand it. And what about the evaluation costs 2500$? There are no tests for adhd. Its diagnosed mainly through a thorough history given by the patient and sometimes records(which you have) from childhood. What is the 2500$ for?


Quote:
I don't like switching doctors when I already have a relationship with a doctor who is willing to continue prescribing the VyVanse, which works well for me, but this re-evaluation is going to cost me like $2500 because my insurance through the affordable care act forced me to change companies and my current NP is out-of-network. My current NP states this is common "best practice" and that any doctor is going to likely require me to be re-evaluated because my diagnosis is so old, but the NP who saw me for the last 3 years never had any issues prescribing the medication!?!? Is this normal or should I begin searching for a new PCP and how does one go about doing that without being viewed in a negative manner. I understand the current abuse-related problems with stimulant medication. To further complicate the situation I received a job offer w/benefits that would become eligible after 90-days. However, the benefits plan through United Health Care lists Vyvanse as non-formulary (aka they aren't gonna pay for it) has a higher deductable & isn't even as good as the plan I currently have (premiums relatively the same after I lose my ACA tax credits). So many factors to consider: seems cheaper to stick with my current insurance even if I have to pay the $2500 b/c vyvanse costs 260/month vs. $75 w/current insurance. Can anyone help, most especially anyone from the Richmond, VA area?
Thats my main concern- what costs 2500$ about this eval and why this new guy is so hell bent on your having to spend it.
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Old 02-17-18, 11:36 AM
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Re: New doctor requiring re-evaluation?!? too exp.!?! (ADHD since childhood).)

Hi Thea, From reading your post, my understanding is;
  • NP's (and you of course) have been managing/prescribing your ADHD.
  • Your NP left and referred you to another NP (maybe in same practice as past or not).
  • New NP (and maybe previous practice) is out of network for current insurance.
  • New NP has prescribed ADHD eval by someone that is out of network (maybe procedure isn't covered).
If my understanding is substantively wrong, pls disregard this post.

If I was in your shoes,
  • I would find out if an eval is covered by your insurance if performed by an in-network provider or if it is 2,500$ no matter what.
  • If it is $2,500 no matter what I would shop for an in-network NP that won't require an eval.
  • Assuming you have a long-term relationship w/ your new NP's practice, I would talk to your NP or someone in their practice and see if they can become in-network.
  • If you don't have a long-term relationship w/ your NP's practice, I would shop for an in-network NP. I would also shop for an In-network Doc if current one isn't in-network.
HTH, -LN
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Old 02-17-18, 03:35 PM
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Re: New doctor requiring re-evaluation?!? too exp.!?! (ADHD since childhood).)

Quote:
Originally Posted by Little Nut View Post
Hi Thea, From reading your post, my understanding is;
  • NP's (and you of course) have been managing/prescribing your ADHD.
  • Your NP left and referred you to another NP (maybe in same practice as past or not).
  • New NP (and maybe previous practice) is out of network for current insurance.
  • New NP has prescribed ADHD eval by someone that is out of network (maybe procedure isn't covered).
If my understanding is substantively wrong, pls disregard this post.

If I was in your shoes,
  • I would find out if an eval is covered by your insurance if performed by an in-network provider or if it is 2,500$ no matter what.
  • If it is $2,500 no matter what I would shop for an in-network NP that won't require an eval.
  • Assuming you have a long-term relationship w/ your new NP's practice, I would talk to your NP or someone in their practice and see if they can become in-network.
  • If you don't have a long-term relationship w/ your NP's practice, I would shop for an in-network NP. I would also shop for an In-network Doc if current one isn't in-network.
HTH, -LN
BUT what the hell are you getting for 2500$??
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Old 02-18-18, 06:04 PM
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Re: New doctor requiring re-evaluation?!? too exp.!?! (ADHD since childhood).)

When I was diagnosed with ADHD, I had to take a whole bunch of random multiple-choice test things, so I can see how going that route could rack up a bill of $2,500. Plus I had to take a drug test and a thyroid test. However, I was not satisfied with this method, and were I not 100% certain that I had ADHD to begin with, I would not have been convinced of this diagnosis. I recommend that you find out what the $2500 testing entails so that you have an understanding of what your doctor expects from you, BUT I would also find somebody who is in your network. Really, you could go talk in person with a qualified professional for a few sessions, and I'm pretty sure that would get you a diagnosis of ADHD. There are no actual tests (blood work, paper tests, etc.) to prove that you have or don't have ADHD.

Also, do you need to stick with Vyvanse, or could you try another medication that would be covered under your new benefits?
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