How to get ADHD diagnosis using insurance

[YazzyN]

It seems very difficult to get an ADHD diagnosis using an insurance, for my 14yo daughter. We are in San Diego, CA, with a Cigna insurance. Any advice will be appreciated!

[Onthemove1971]

Thanks for joining the group. We started with our son's doctor and they refererred us to a parent informational group. We then spent one on one time with a psychologist who we filled our survey forms. We then asked his teacher to fill out a survey. Then a diagnosis was made. He has been recieving: medication, therapy, an educational plan ( 504 plan) and does exercise daily. These all together help him decrease the symptoms of ADHD. I make it sound simple, there are ups and downs but this group has been a key to supporting me in the journey.

Best of luck!!

[2ADHDkids]

We easily got one through our pediatrician for our oldest. You ask for an ADHD screener like the Vanderbilt. There is a version for parent and one for teachers…maybe one for the kid once they are old enough. The doctor then scored them and can give a diagnosis. She the wrote a letter that we shared with the school.

We also then did a neuropsych a couple of years later to get more information, but our daughter an ADHD diagnosis added to her IEP based on the pediatrician’s letter.

[GhostOrchid]

We have Cigna but live in a different state. We just scheduled an appointment with my son’s doctor like we would for any other illness or injury. There were no extra steps involved with getting them to cover an ADHD evaluation & diagnosis with the pediatrician. It has been a few years, but I’m sure there was a copay and or coinsurance required, but again, it was the same as an illness or injury. Psycological or PsycoEducational evaluations were a different story! After reading through our policy and speaking with different folks at Cigna, it was apparent they were not going to cover it. I don’t recall the specifics, but it was a very narrow scope of reasons they would cover it. I believe it had to be driven by a medical reason vs educational reason. We paid out of pocket ($2000-$3000) and didn’t process it through the insurance since they weren’t going to pay. One provider offered a cash discount if we didn’t go through insurance.

[Crazyboymomma]

we initially got my son’s diagnosis through his pediatrician and it was a simple process. Just this summer though, we had neuropsych testing done and they did take our insurance! I would maybe try calling around to the different testing centers to see who takes insurance.

[Knitting20projects]

You shouldn’t need expensive psychological testing unless it’s really unclear what is going on. I would start with your pediatrician. It’s possible that, based on a good history and physical, plus additional data gathering from caregivers and teachers, that you can get a diagnosis without additional testing. In many cases that’s sufficient. I hope this helps!!!! ADHD really should be a diagnosis made by history, and observation, unless there are concerns for a more complex situation like autism with ADHD, intellectual disability, etc.

[ADHD_DAD]

The general rule of thumb is MD will be covered, PhD maybe not. So pediatrician, pediatric neurologist, psychiaTRIST (as opposed to psychOLOGIST) should be covered. You can fight for coverage for others, but perhaps this will get you what you need.