Insurance not paying for ADHD dx | ADHD Information

I'be been informed by my carrier that our company's insurance policy doesn't reimburse for anything related to the ADHD diagnosis.  They classify diagnosis as mental health related which they don't cover.  Which means I'm paying everything out of pocket. 

Has anyone had experience battling with their insurance company about the interpretation of ADHD?  It is a neurological dysfunction which has a medical basis.  Its a medical disability, no?

I used to work for a major health insurance coverage and it's true they do consider ADHD as a mental health disorder not medical so if you have mental behavior benefits that is where it would be covered.  Sometimes another carrier not medical covers your mental health..I would double check with the employer your insurance is through.  Good luck though..I know it's a challange.Yes, ADHD is a mental health condition in terms of insurance. I have two insurance companies. One is Blue Cross Blue Shield and they have an Exclusion listed in the policy for ADHD. Look at your Exclusions. I bet it's in there.Same here, I have Blue Cross for medical, but they consider ADHD a
Behavioral Health issue. My employer also provides EAP and mental health
services from a company called Magellan, but they have a rather limited
group of providers. We had an initial diagnosis from a Magellan doctor,
then his pediatrician managed his meds for the first year or two. My son
has had lots of ear problems, so the doctor's office would just code the
visits as ear checks so Blue Cross would pay. The topper was, for a while
it looked like my son could be on the autistic spectrum, but when a
Magellan psychologist submitted a bill for payment with that code, they
denied it, because they don't "do" autism, because it is developmental,
not behavioral health! Here I am just trying to figure out what is wrong,
but I am supposed to know what the problem is before seeking services
so I know who to go to. To find out what the problem is. Arghhh.ADHD is a mental health diability, as far as the insuracne company is concerned. We pay 100% out of pocket for dd's meds and therapy. our doctor does not take insurance, so we pay him out of pocket, but any other things we've done it was covered by mental health coverage. Our meds are covered under our prescription plan with a co-pay.

My insurance co. (Carefirst) seems to be just making it up as they go along.  Intially they covered 100% of the office visits to the ped., but when we went to get a neuropysch evaluation they claimed it wasn't covered because ADHD is a learning disability (?)!  However they still covered all ped. visits for med checks and the prescription plan covers his meds.  Then last fall we were informed that adhd is covered under mental health care and would be billed 80/20 (insurance pays 80%, we pay 20%).  It all seems kind of arbitrary.

Personally, I feel they should be required to provide mental health coverage to everyone that has any type of plan- it shouldn't be seperate.  It should also cost the same and be very straightforward, instead of more complicated than all their other plans combined. 

Thank you so much for everyone's reply.  Mental health is not covered under my current insurance plan.  My company is switching to Aetna by the end of this month and so I hope they cover it.  Considering how prevalent the diagnosis is I just couldn't believe they wouldn't cover it.  Medical insurance is following the trend of home insurance-- traumas and disasters only.  Something needs to change.  When you switch, if ADHD is covered, they'll still do the pre-existing condition thing. If your insurance is through your employer they can only exclude a pre existing condition for six months. Of course, if there is no record of ADHD, then you can say it's not a pre existing condition. I guess it depends on what your ped has on file.

My district's insurance plan changes frequently....they are always trying to find us something better for the money...we have never had any problems with "pre-existing" issues.  No matter what company we are with under my employer ad/hd has been covered.  We may have to pay a slightly different amount but it is still covered. 

sidenote: our plan covers ad/hd under the medical portion and his therapy under the mental health.  So surely there are other plans that do the same.

4myson39502.3654282407Hello everyone.  I was curious to know if adhd medications is covered under the govermental insurance such as child health plus. My son is currently on daytrana and it cost me 6 monthly. This is such a great med for him but it is so pricey. Does anyone have any suggestions?My insurance company - Aetna - only covers ADHD if it's a result of an injury.  Unfortunately my employer switched from Blue Cross/Blue Shield, which covered everything, at the beginning of the year.  Supposedly the new company is supposed to cover everything the first company did.  Fat chance of that.  I welcome the fight I have on my hands with them, because it's a relief to have something to go after beside my son's school!