insurance problems | ADHD Information

I need help here. Refresher: our dr retired and new dr changed sons meds from Foculin which he has been on for years to concerta which did not work for him. Could not get help from dr, no calls back, got frustrated. After seeing him once, told me my son has crumpled ears, wants genetic testing etc...

Now, went to regular pedicatrician this am and he agreedto take over dosing of meds for child, no problem. He also wants son in counseling as long as he is getting meds. Child is in a social skills class right now that ends in 2 weeks.

Problem: Insurance says it will not pay for counseling for child. Dr stated he will not medicate without counseling. I am in a tight place. Any ideas what to do?

Check into the county counseling center...see if they will work with you on price...mine gave Chase counseling on a sliding scale for income...

Maybe yours will too. It went by our income, but when they came back and said " a session", and I said, "well I guess we cant do counseling then" they came down in price to something we could afford.

I hate insurance companies. Why won't your Dr. medicate without counceling?

Why won't the insurance company pay? Do you not have a mental health benefit?

I would check with your State's mental health Department or dept. of children's services. I know there are programs to help people on limited incomes. You just have to search them out.

Also, call local hospitals and ask about such programs.

Good luck.

I spoke with his dr who stated that ADHD is NOT a learning disability. He is writing a letter to that effect and I am taking that letter to insurance to get him approved. Of course, I am sure they ( insurance ) will find some way to wiggle out of it.

Did the insurance give you a reason or is it just not covered in your policy?

Sometimes you can argue them into it or have you doctor help figure out a way to make counseling "medically nessecary".

Or you could find someone with a sliding scale until you're able to get in with another psych?

Insurance stated to me that they will not pay benefits for counseling for ADHD as they have it listen as a learning disability. They stated that the dr could call them but if he states it is for ADHD, they will deny it. He has to be diagnosed with a mental disorder in order to qualify for counseling. That really makes me mad. The original dr stated he was OD which both myself and his teacher think is incorrect. She has an OD child and stated he is NOT.

So, do I or the DR have to lie in order to get him counseling?

i did go through the county for financial reasons daytrana and doctor every month cost 250 or more. I will say that I spent a long time on the phone only to find out that if I have a 401k , my son is not eligible. I am a single mom without child support and this was very frustrating to me. So if you do call get the county get the facts up front and try to talk to someone who has experience. I had no luck, I'm sorry about your situation I am in the same boat. And just today we to the doctor who prescribed risperidol for summer, my son was in tears. I also have insurance but doesn't cover mental health. Its very frustrating I know.[QUOTE=longsally]

So, do I or the DR have to lie in order to get him counseling?

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ARGHH!!! I, too, hate insurance companies!! Mine told me when I wanted to switch to a plan with better prescription coverage after Chase was dx with ADHD (while insured with them), that ADHD IS a mental disorder, and that if I switch to the new plan, the ADHD will be denied......it SUCKS!!

Longsally,

We went to Boston Children's hospital for a evaluation when ds was 2. At time son was speech delayed. They looked at autism, NOT. However, they did mention his ears, which was bizarre!!!

I felt like the doctor, a woman from India, was picking on my son! That too was unfounded, however, I did complain. The report was pathetic, and at our insurance companies expense. They never even mentioned ADHD. I actually was the first to diagnose when he was 4, then the pediatric neuropsych officially did at the age almost 5.

I ended up having him re-evaluated at another Children's hospital for the ADHD diagnosis.

But I wanted to ask if you can let us know if anything comes from the comment about his ears - "crumpled ears" ? What does that mean???

Thanks,

Beth

The physicians look at ears as this is a common physical trait for a lot of syndromes. It is not unusual that they comment on ears. My daughter has had quite a bit of genetic testing and they measure her ears EVERY time. Please dont take offense to this, it is completely justified practice.

Bedside manner is another thing, but the actual practice is justified.

I dont take offense to the ears but the thing is, my husband has very small ears. They used to call him hippo in school. The dr asked who he looked like. Duh: I have black hair and brown eyes. Child is Blond with green eyes, showed dr picture of husband btw before the comment was made. Guess who has that coloring?

He also told me child has OD. This child does NOT go out of the way to annoy people. He does not refuse to do things, he is not argumentative. His teacher has an OD child and when I told her, she stated that my DS was NOT od by any stretch of the imagination.

As it turns out, that OD diagnosis ma be what gets him into therapy. Isnt that ironic?

isnt it always the way, hey take it however you can get it right

How frustrating!! Well, do whatever you can to get the insurance co. to pay. If you have to call it a mental dissorder - do it. ADHD is not a learning dissability and by the way, why wouldn't they cover a therapist for kids with learning dissabilities? Having to deal with a learning dissability can bring upon anxiety and depression. AGGGGG - yes, I'm afraid they will do anything they can to not pay.

To bad you can't switch to a different insurance plan. Sadly, I had to switch to a very expensive plan so I can make sure my son gets covered. I am fortunate that I work for my father so we have the plan but I have to pay for half of it, and let me tell you, after paying for the insurance, it doesn't leave much money left.

Look up Timothys law and see if that would help you, do not give up. I plan on looking for counseling for my girl to help with socialization skills as for insurance I will cross the bridge when I get there. Also can the doctor have it overode by talking to the company doctors do have some authority.