Health Insurance and Adderall

December 24, 2004 6:15 PM

Seven years ago, I was in college and on my parent's insurance, which included mental health coverage. I was diagnosed with ADD and prescribed Adderall which did wonders for my concentration and my grades. When school was through I lost my coverage and my prescription. (MI)
posted by cilantro to health (14 comments total)

Now I have my own insurance, but it doesn't cover mental health care. I'm back in college and it would be wonderful to have an Adderall prescription again. If I explain all this to my regular doctor (who I've only seen once), will he help me out, or will he think I'm fishing for drugs ? Adderall is pretty commonly used and sold illicitly, especially during finals week. I've tried getting hold of my records from my old psychiatrist, but she was a year from retirement when I was seeing her and the practice she worked from with two other doctors no longer seems to exist.
posted by cilantro at 6:17 PM on December 24, 2004

I may not be able to directly answer your question, but I can certainly relate to your experience with Adderall.
posted by Keyser Soze at 6:28 PM on December 24, 2004

If your doctor prescribes it, it should be covered, i.e., you are not going outside the system for a mental health eval.

Can you get your medical records?

Most physicians regard Adderall as an appropriate drug for the right situation. If you have records from before, especially a consult or eval from a psychologist, I would be surprised if you had any problem. You might be asked to be re-evaluated by a psych first, but from then on I doubt it would be an issue.
posted by docpops at 7:25 PM on December 24, 2004

And FYI, if it matters, at the risk of this sounding, well, sounding like anything, use common sense.

Dress well, speak politely, don't wait five seconds to meet your doctor's eye/handshake while you put down that dog-eared copy of Oprah or Trailer-life, and don't open with a request for Adderall. Just start by explaining your history, as well as what is currently going on before leading up to a query about whether or not he/she might consider prescribing it.
posted by docpops at 7:29 PM on December 24, 2004

Here is basically what I said:

"Hello doctor. How are you? Good to hear. No, no pains anywhere. I really wanted to speak to you about going back onto Adderall. To be honest, I want to do better in school and work. Well, you see, I can't focus in class. I get this 1000 yard stare. I used to think I was just lazy, but I really want to do the work. What do you recommend?"

For you add:

I used to be on it between (date) and (date) and I didn't take it on the weekends.
posted by Keyser Soze at 9:25 PM on December 24, 2004

It's important you paint the picture that you do not find it addictive and its benefits were tremendous to your studies.
posted by Keyser Soze at 9:26 PM on December 24, 2004

Don't be glib. Don't ever pretend you are interested in the doc's day/well being/family, etc. unless you really, really have an established history. He'll immediately suspect you for drug-seeking. Just tell the truth and get on with it.
posted by docpops at 9:56 PM on December 24, 2004

If you've had a prescription for this in the past--and have the paperwork to prove it--why would the doctor think that you're trying to get an illegal high out of him?
posted by interrobang at 10:19 PM on December 24, 2004

I was on a lot of adderall for a long time, and I think you're worrying about nothing. Sure, it's used illicitly, but a lot of people get it on prescription. You're dealing with someone whose job it is to understand you better than you understand yourself, and the truth is that you have nothing to hide, so you can only hurt yourself by making a production out of this. Write down all the information you have about your last doctor and your treatment, maybe some old empty bottles from the pharmacy, bring it with you, and explain the situation. If you are truly ADD and the new doctor is halfway competent, he/she will believe you and write you a scrip.
posted by bingo at 8:54 AM on December 25, 2004

If you've had a prescription for this in the past--and have the paperwork to prove it--why would the doctor think that you're trying to get an illegal high out of him?
As I stated in the original post, my former psychiatrist is retired and the practice she shared with two other doctors (in a city, incidentally, that's ten hours away from where I live now) no longer exists. I've internetted all the information I can remember about my former doctor and haven't been able to locate her. I can't remember the names of her colleagues, either. That's the problem, I can't find a way to establish my prior medical history, and I can't afford to go to another psychiatrist to be re-diagnosed.
I don't have very much experience with doctors--only went to a psychiatrist when I was about to fail out of school and couldn't figure out why, only go to regular doctors when I am terribly, terribly ill. Maybe once every five years. So, if I seem terribly clueless, that's why. All of the advice here is great, though. I'll see what happens at my appointment next week.
posted by cilantro at 7:32 PM on December 25, 2004

you can doctor shop, and without too much effort find one who will serve your purposes...
posted by Fupped Duck at 9:06 PM on December 25, 2004

If your doctor prescribes it, it should be covered, i.e., you are not going outside the system for a mental health eval.

Someone please call me on this if I'm wrong, but I'm pretty sure that the insurance companies decide what does and does not fall under the heading of mental health/psychiatric based on the diagnosis (or possibly even the treatment) and not on the type of doctor you go see. I think I've had general practitioners write me prescriptions for anti-depressants only to find later that insurance only paid fifty percent of the tab because the diagnosis was depression. My impression at the time was that insurance companies had identified the potential loophole and made sure it was closed lest they be stuck with the tab for a couple hundred thousand Prozac prescriptions every year. (Not that this justifies their sliminess).

Regarding doctor shopping: Yeah, you really can do it. Not only that, but you should do it. I remember when Rush Limbaugh got busted and they said one of the charges was doctor shopping. I was like "that's a crime??" Hell, If I hadn't done it and done it often, I might be dead by now. And no, I'm not saying that you should go around scoring drugs from medical professionals. Rather, I'm saying that you have to know what you're getting before you buy. We've been told repeatedly that medical care is subject to the rules of the marketplace and that we are simply consumers. Well, if we're consumers, then we should, by god, be smart consumers.
posted by Clay201 at 2:07 AM on December 26, 2004

Health care is an industry now. We are all consumers, so you have to advocate for yourself just like you would in any consumer-type situation. Think about an analogy - if you had a repair that worked for your car, and you're now going to a different mechanic, you'd tell the new guy what the old guys did.

Health care is in the same paradigm now. You don't have to feel concerned about being your own advocate - just be straightforward, explain what the situation is (including the fact that your old psychiatrist is apparently no longer reachable). Have the expectation that this is entirely reasonable. Your new doc will probably be grateful that you have a clear idea of what's wrong and what you need. He may also have some new meds that he's heard of that he may offer you, which you're free to either try or not.
posted by jasper411 at 2:51 PM on December 26, 2004

I agree, explain it to your doctor. If he wants to refer you to a psychiatrist to be re-evaluated, check with your insurance company. It's possible that they would cover the evaluation if it were a referral from your GP (or PCP, depending on your type of insurance). However, general practice doctors have to go through schooling for psychiatry as well, and so he may be able to diagnose you himself.

Most insurance companies do pay according to diagnosis. However, once again you should check with your insurance company, because I do know that some pay according to prescribing doctor (I work in health insurance/managed care).

If you can get the prescription from your doctor, you don't necessarily have to get the meds through your insurance. You can check Needy Meds for assistance programs (they don't have brand name Adderall in their list, but they have the generic dextroamphetamine, and they have Strattera). Also sometimes doctors get samples of medications, and they give those out to needy patients. Your doctor or pharmacist will probably know other assistance programs as well.

Finally, if you can afford a small amount, you might want to check with psychiatrists. Many of them will charge on a sliding scale. One of mine only charged me $15 for a few visits when I couldn't afford more than that. It's possible that you could find one that would charge you what you can afford. And they would also be able to give you med samples. Or if you have a county mental health center, those are low cost and provide low cost meds.
posted by veronitron at 4:57 PM on December 26, 2004