attention magazine October 2018
“help! how can i get an adhd evaluation when my insurance does not provide adequate coverage? many doctors in my area are not accepting new patients or do not participate in my insurance plan or charge too much. I’m not rich enough to pay for it myself.”
“How can I evaluate and treat my child for ADHD? it’s too expensive and we can’t afford it. Can anybody help me please?
chadd gets inquiries like these all too often. Insurance companies generally pay for standard doctor visits, but many don’t pay for lengthy evaluations. psychological tests typically take hours and can cost thousands of dollars. many doctors evaluate without tests or lengthy interviews. But even if a doctor is very knowledgeable about ADHD, a 20-minute visit is usually not adequate.
How common is the affordability issue? Additude magazine recently conducted a comprehensive online survey of more than 600 US participants. These are some of their findings.
● More than 16 percent of respondents reported that the costs of managing ADHD exceeded 10 percent of their family income.
● 65% of survey participants, with and without insurance, said the costs of care had affected their ability to treat their ADHD.
● Only about 8 percent said their plans paid 100 percent of drug and treatment costs.
● Just over 7 percent said their plans didn’t pay for any of these costs.
● Nearly 25 percent of survey participants who had insurance said their plans paid less for care in 2017 than before.
● More than 50 percent said insurance had limited them from taking the medications they wanted.
● 23 percent said it had greatly affected that ability, limiting and sometimes eliminating treatment options. A 2012 study published in the Journal of the American Academy of Child and Adolescent Psychiatry estimated annual costs of ADHD care at up to $2,720 for children and $4,120 for adults. additude’s survey suggests that these costs were underestimated, especially when costs included non-medical strategies such as training, tutoring, over-the-counter supplements and vitamins, neurofeedback, etc., not to mention costs incurred with common coexisting conditions such as depression, anxiety, sleep disorders and substance abuse.
● On average, respondents estimated $3,509 in annual spending for “non-medical” costs they associated with ADHD care.
● 84% said they lived with one or more diagnoses (such as anxiety, depression, or learning disabilities) in addition to ADHD in their household.
When it comes to finding low-cost screening and treatment for ADHD, there’s good news and bad news. The good news is that there are many resources available. The bad news is that you’ll have to do some research to find them.
To help you find affordable evaluations and treatments when insurance coverage isn’t available and rates are too high, members of the care editorial advisory board have come together. compiled these 19 tips from their collective wisdom and experiences.
If you’re an adult with ADHD or a parent surrounded by chaos, this project can be a real challenge. this is a good time to be creative. perhaps a friend or family member could help you with this investigation in exchange for something they need to do. don’t be afraid to ask for help. many people feel that the support they receive from other people or parents is the strongest help they have. Take advantage of organizations like Chadd and his National Resource Center on ADHD, Adda, Nami, the Learning Disabilities Association, etc. These national groups offer valuable support and education, as well as helpful educational materials such as books, audiobooks, articles, podcasts, and brochures. They provide services (in person and online) through support groups, training programs, phone contact, online communities, blogs, conferences, and newsletters. much of the help these organizations offer is available for free.
Your pediatrician or primary care physician can perform the evaluation. however, keep in mind that the experience of adhd varies greatly, especially with adults. To make your doctor’s job easier, you and a teacher can complete an assessment checklist before your visit. The American Academy of Pediatrics has an ADHD Toolkit with an ADHD Screening Checklist and Treatment Recommendations. this set of tools is available for medical and non-medical people. The AAP Toolkit provides Vanderbilt Rating Scales for Parents and Teachers; you can find the toolkit at aap.org. You can also download Vanderbilt rating scales from other websites. Adult clinicians vary widely in their use of assessment tools for ADHD. For an adult ADHD assessment, you can download checklists such as the Adult ADHD Self-Report Scale (ASRSV1.1) or the ADHD Rating Scale (ADHD-RS-IV).
Your doctor may refer you to another specialist. a psychiatrist or psychologist can do the evaluation. Your doctor may be able to connect with a professional colleague who will do a pro bono or sliding scale evaluation, or medication review, or even help with behavioral parent training.
If your child is having significant problems in school, he or she may qualify for extensive psychological and educational testing by school personnel. First, ask through the principal’s office for the educational management team. If approved, the school’s evaluation may include a comprehensive evaluation for ADHD, learning disabilities, and psychosocial difficulties. If your child has significantly limited availability for learning due to ADHD, federal law requires the school to provide the necessary accommodations and interventions. Although the school cannot prescribe medication, your doctor may review the school report and possibly continue treatment.
many counties have behavioral clinics that can help an adult or child with evaluation and treatment. Your local county mental health centers and community service boards may provide evaluation and treatment services on a sliding scale. The Substance Abuse Mental Health Services Administration website lists these programs nationally. There are also county early intervention programs that will provide services for very young children who need follow-up testing and services. Under the US Department of Education, Parent Information and Resource Centers across the state help parents of children with disabilities find resources and provide up-to-date training. For therapy or behavior management, group therapy or training may be more affordable than individual therapy.
Some hospital clinics offer services free of charge or on a sliding scale. Hospital clinics are more likely to participate with a wide range of insurance plans. Many hospitals have interns and residents in training who provide treatment under the guidance of a mentor. Some hospitals for adults and children have specialized ADHD clinics that take finances into account. Hospitals that are part of a large health care system may also have outpatient clinics for low-income or uninsured children or adults. some of these centers will consider sliding scale or free fees.
There are county medical clinics in every state. These clinics provide health care to low-income, uninsured families. they may be able to arrange services with outside specialists if they are unable to perform the treatment themselves. These clinics can also provide help with medications. to find these centers, visit the websites of the health resources & amp; services administration or the national association of free and charitable clinics.
University and college programs established training centers for future physicians, psychologists, and social workers. your local colleges may have such a program. this could make evaluation and counseling affordable.
Clinical research programs may qualify adults or children for ADHD evaluation and treatment. check with your local academic hospital or the national institute of mental health to see if one of their studies might be a good fit.
see adhd websites such as addfreesources.net for information on finding free resources and evaluation forms.
Parents can keep their children on their private health insurance plan until age 26. Most states allow children with disabilities who are unable to support themselves to remain on their parents’ insurance after age 26.
Check if you qualify for Medicaid in your state. some states qualify both adults and children, although some only cover children. There is also a federal program called the Children’s Health Insurance Program (CHIP). This state program qualifies children of working parents who have incomes above Medicaid requirements. A family of four in Virginia can have an annual income of $32,256, while a family of four in Texas can have a maximum income of $21,404 to qualify under the chip program.
County social service agencies can help you find county, state, and federal funds for the services and treatment you need. Find your local office through your state government website; for example, alabama – department of social services.
Churches and faith-based social service agencies can also direct you to services in your area. Organizations such as Lutheran Social Services, Catholic Charities, The Salvation Army, United Methodist Ministries, Jewish Social Services, etc. they can help you get the services you need and provide limited financial assistance.
some foundations provide local health care; For example, the Children’s Association Foundation in Springfield, Virginia. Some national foundations can also help, such as the Children’s Health Fund for Children with Medical Needs or the Healthwell Foundation, which provides funding lists for specific diseases. the foundations work with local agencies and hospitals to help those individuals and families who are not covered by other programs.
each state’s department of vocational rehabilitation provides evaluations, financial assistance, referrals to training programs, and counseling for adults with varying degrees of disabilities.
supplemental security income (ssi) and social security disability (ssdi) are federal programs for children and adults with more severe disabilities who qualify for financial and medical assistance.
Pharmaceutical companies and pharmacy networks often have prescription assistance programs to help offset the cost of your medications. In addition, some nonprofit programs help pay for drugs or offer discounts on prescription drug prices. for example, needymeds.org, rxoutreach.org, goodrx.com, and togetherrxaccess.com. dispensary of hope is a charity drug distributor, but it only operates in a few states.
and remember, one of the benefits of chadd membership is a free prescription discount card. all chadd members and their families have access to the chadd una prescription discount card. simply download your card and receive savings of up to 75 percent at more than 50,000 national and regional pharmacies. you can create as many cards as you need. Participating pharmacies include CVS, Kmart Pharmacy, Walgreens, Publix, Winn-Dixie and Albertsons, as well as thousands of independent pharmacies.
One thing to keep in mind is that generic short-release versions of methylphenidate or an amphetamine (although taken 2 or 3 times a day) are cheaper than the premium prices paid for extended-release products, since whether generic or brand name.
Remember that self-training is the key to success with ADHD. There are many people and organizations to help you!