ADHD Health Insurance Coverage: Should You Pursue an ADHD Diagnosis?

ADHD health insurance coverage problems are common issues with parents. Does health insurance cover doctor visits for ADHD diagnosis? This was a recent question I received from a Healthy Family reader. Unlike a learning disability, which is often not covered by medical insurance, ADHD health insurance coverage is possible. This is because ADHD is considered a mental health issue. Many health insurance companies will cover at least a portion of your costs when you make doctor visits for an ADHD diagnosis. How much of the cost is covered? How many visits are covered? Is medication covered? These things will depend on your individual insurance carrier.

ADHD Health Insurance Coverage is Possible

So my answer is, yes. Many times health insurance will cover your doctor visits for ADHD. But there is a huge caveat. In order to lower costs, ADHD health insurance coverage can often be denied by your carrier. For example, your ADHD health insurance coverage may require you to pay all costs for the first year of treatment. They may also flat out deny the claim for other reasons. If this happens to you, and you believe you deserve that ADHD health insurance coverage, make an appeal.

getting ADHD health insurance coverage for your adhd diagnosed student.
Investigate your provider’s ADHD health insurance coverage for your child.

My best advice to parents looking to have their child diagnosed is to call their insurance carrier and inquire ahead of time. Then look into the mental health insurance laws in your state. Be sure you ask your insurance agent about your ADHD health insurance coverage in your plan. Ask specifically if mental health issues  are covered by your plan and if so, what is the coverage. Be sure to explain that the visit is for a medical issue and not for a psychological one. Some insurance carriers do not cover for marital or child counseling needs, for example, but will cover doctor visits for ADHD.

When you understand the law and your ADHD health insurance coverage you can make an appeal if you’ve been wrongly denied. Most states have an appeal board and will rule on your ADHD health insurance coverage issue independently. For local Chicago area readers, visit the Illinois Department of Insurance to file a complaint. If you are from europe I believe you have to apply for an ehic. If you are curious to learn about your ADHD health insurance coverage options in Illinois and how they will likely change under the Affordable Health Care Act, visit the HIRIC.

My Overall Recommendation for Private School Parents on Seeking an ADHD Diagnosis:

You may have ADHD health insurance coverage, but does your child really have ADHD? There is no laboratory test for ADHD. It is a clinical diagnosis. This means that the doctor does not do a blood or urine sample to determine whether or not your child has ADHD. In most cases, diagnosis involves a series of interviews with the doctor and behavioral analysis from parents, caregivers, and teachers. An ADHD diagnosis means that your child has enough symptoms that fit with the definition of what ADHD is.

What are the Symptoms of ADHD?

Children and adults with ADHD symptoms will fall into one or more of three categories:

INATTENTION HYPERACTIVITY IMPULSIVITY
messy work fidgets blurts out answers
doesn’t pay attention out of seat a lot has problems taking turns
easily distracted excessive running interrupts others
can’t stay on task excessive climbing shows impatience
has incomplete assignments excessive talking talks out of turn
procrastinates often louder than peers intrudes on others socially
disorganized constant pacing or movement talks at inappropriate times
forgetful inappropriate jumping has difficulty waiting
doesn’t follow conversations inability to stand still shows emotions without constraint
forgets daily activities moves fast, touching everything in room acts without considering consequences

Does My Child have ADHD if they Show at Least Six of the Above Symptoms of ADHD?

Maybe.

Remember, ADHD is a clinical diagnosis. It is possible that another condition that causes similar symptoms is the root cause of your child’s ADHD symptoms. These other conditions often require blood and/or urine testing for a diagnosis. If you have ADHD health insurance coverage, you may also have coverage for additional lab testing for associated conditions. It is possible that your child does have ADHD if they exhibit 6 or more of the above symptoms of ADHD. But is is also possible something else is causing your child’s many symptoms of hyperactivity, inattention, and impulsivity.  Your doctor will know best what kinds of diagnostic tests to run, based on your child’s other symptoms. Usually doctors will rule out other conditions before diagnosing your child with ADHD.

What is a clinical diagnosis? When getting a clinical diagnosis for ADHD, the parent will visit a doctor with their child. The doctor will interview the child, probably on more than one occasion. Then the doctor will ask for a behavior analysis from parents, caregivers, and teachers. A behavior analysis is a series of questions and ratings about the child’s behaviors in school and at home. This will vary in form and function depending on where you live. The Mayo Clinic explains the process of diagnosis very well.

I Advise Seeing an Audiologist if Your Child’s Symptoms are Mainly Related to Listening Comprehension Issues

This is especially true if you have a child in a private school that doesn’t have a special education program available. Children diagnosed with ADHD require an IEP (Individual Education Plan). This report is done at the local public school in your district. In some cases, the child will have an auditory processing disorder. This is not the same thing as hearing loss. It has to do with the brain’s ability to process sounds in the environment correctly. If you plan to have your child tested for an auditory processing disorder be sure you find an audiologist who specializes in processing disorders. Here in the Chicago area we are fortunate to have well known audiologist Jeanane Ferre, in Oak Park.

As Always, Regular Healthy Family Readers Know I Advocate for a Healthy Organic Diet!

As an educator and as a parent, I have seen how a good all natural organic diet can help lessen symptoms of ADHD. If you have ADHD health insurance coverage and you’ve been to your doctor, consider trying a healthy organic diet before using ADHD medication. You may learn that a diet high in omega 3 fatty acids, organic fruit and vegetables, no artificial colors, flavors, or preservatives will help your child feel much better.

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