Insurance Co Stinks | ADHD Information

For us we are only allowed 6 psychologist visits per year with our insurance.  I thought they were changing the laws on this because of Timothys Law.  Timothy was a young boy who needed a lot of help and insurance pulled the same stuff and the family could not afford the extra and he ended up commiting suicide.

We have NO mental health coverage on our insurance.    We pretty much have to pay for everything out of pocket - plus the premiums for the health insurance policy.   It really sucks.    At least the psychiatric nurse practitioner we use for medication management is covered.   I'm not sure why she is but I am not going to ask...

On top of all of the medical stuff,  we have two sets of braces and dentals bills as well. 

Good luck with your new therapist.

Well I called my insurance co yesterday just to check out the child issue and not only are we limited to 30 visits a year it is for the whole family. OMG how am I supposed to take care of myself and my son with a chronic condition with 30 visits? this is ridiculous. My hubby's company is a huge nationwide company and has the worst insurance for the highest price I have ever seen. It gets worse every year. I am already worried about next year's 6000.00 out of pocket. Are you kidding? and I checked with the HMO route and none of the doctors here, Reputable anyway take it. So we are stuck. Just another vent. Thanks

I really feel for you and can relate to your distress.  Maybe you could check into medical assistance to cover beyond what insurance covers?  Don't know if this is an option for you.

My son had 6-mo. period ('05 through '06) with a great therapist, outpatient psych at local hospital. Our medical insurance specifically shows coverage (limited visits) to 50% after 0 deductible for these services.  Well, after cessation of visits, everything was in order, expenses being paid out of pocket, deductible met, claims filed correctly through insurance, and we're STILL going back and forth with insurance co. waiting for reimbursement due us/they admit to making filing error; major headache!!! 

At present, my son will be starting back with the same therapist and he feels comfortable with him, for which I am happy; but at the same time, I'm taking a deep breath and crossing my fingers when I think about the bill juggling we'll have to do.

Good luck.  Hope there may be an alternative for you.

[QUOTE=spamula]We just found out our insurance only pays for 30 phsych visits per year. That's not enough to even cover 1/2 of what we need here, and we cannot afford more. I figured out if they will bill family visits to myself or husband that helps but for my son, since he won't take meds that is not going to work. If he took his meds and did his social skills classes or some play theray he might not need it every week, but without the meds(he won't take) we are up the creek without a paddle. How do I juggle the insurance around? I don't really expect an answer on that one. I also have a 6000.00 out of pocket at the begining of the year. How the heck am I supposed to pay for that? The company pays the 1st 2000.00 then I have to come up with the rest. we are barely paying our bills right now. Does this ever stop? when will the anxiety of dealing with all this go away? I am done. I have had enough. This is the worst insurance I have ever had. And it is a BIG company. Stinks! Thanks for the rant.[/QUOTE]

Send a public letter to Michael Moore, the democrats anyone else that can help and cc it to the insurance company demanding better care.

For your own sanity--use your anger and upset to promote national health insurance.

The Political IS the personal.
I would call the insurance company and ask lots of questions. To my knowledge, they have the rule of 30 or so visits per year, but it's not real. Ask them if they consider ADHD to be a chronic or severe mental health condition. Ask them about whether the number of visits per year is determined on a case by case basis for a CHILD. You need to emphasize the child part. With my insurance company it turned out that ADHD is considered a chronic and severe mental condition and there really is not limit. If there is a need, and the patient is a child, they authorize according to what the child needs, not according to some arbitrary number.Mine is the same as NoTellin says, with a child it is unlimited, but they only approve 10 visits at a time.We just found out our insurance only pays for 30 phsych visits per year. That's not enough to even cover 1/2 of what we need here, and we cannot afford more. I figured out if they will bill family visits to myself or husband that helps but for my son, since he won't take meds that is not going to work. If he took his meds and did his social skills classes or some play theray he might not need it every week, but without the meds(he won't take) we are up the creek without a paddle. How do I juggle the insurance around? I don't really expect an answer on that one. I also have a 6000.00 out of pocket at the begining of the year. How the heck am I supposed to pay for that? The company pays the 1st 2000.00 then I have to come up with the rest. we are barely paying our bills right now. Does this ever stop? when will the anxiety of dealing with all this go away? I am done. I have had enough. This is the worst insurance I have ever had. And it is a BIG company. Stinks! Thanks for the rant.

That really sucks!

I can never keep up with our insurance- it seems like they're changing things every year, as far as what's covered and our out- of- pocket expenses.

Could you get away with going every other week?  Play therapy is great if you can find some one in your area- will the insurance cover that?  It helped my son a lot.  The woman we see won't deal with insurance companies, though (gee, I wonder why?), so we have to submit it ourselves.  A hassle, but she's worth it.

Hang in there.  

DUE TO THE FACT THAT MY SON WILL NOT TAKE HIS MEDS, HE NEEDS EVERY WEEK NOW. HE DOES DO PLAY THERAPY AS PART OF HIS SESSION. THE THERAPIST IS NOT COVERED BY MY INSURANCE EITHER, AND HAS TO BE SUBMITTED BY ME. WE CAN NO LONGER AFFORD THIS SO IN A COUPLE OF WEEKS WE HAVE AN APPT. WITH A NEW PSYCHIATRIST WHO WILL GIVE US NAMES OF THERAPISTS WHO ARE ON OUR INSURANCE AND HOPEFULLY WE CAN FIND ONE THAT WILL BE GOOD FOR MY SON. HE DOES BEST WITH YOUNG MALES. hOPEFULLY THEY WILL BE ABLE TO WORK WITH US TO HELP HIM. i PRAY THAT THIS NEW GUY IS GOING TO BE GOOD, HE DID COME REFFERED BY OUR PEDIATRITIAN AS WELL AND IS ON OUR INSURANCE. THANKS