Can I afford to have ADD?

June 23, 2012 6:42 PM

What can you tell me about adult diagnoses of ADD and how they work with health insurance, specifically the idea of pre-existing conditions?

I believe I have undiagnosed ADD (and have had it for a while). I recently graduated college and started a job, and I'd really, really like to look into an official diagnosis and possible treatment.

I know this will vary, but how does health insurance (I'm in the US) typically treat something like this? I'm still on my parents' health insurance, but will probably be going off of it within the next year. My father frightened me when I was little with the idea of pre-existing conditions, but I really have no understanding of them. Will a diagnosis whilst under their insurance preclude me from being covered when I switch to my own? If the answer is yes, then I would wait until I'm on my own insurance, but I'd really rather not wait.

I know insurances can vary wildly, but what can you tell me about your experience with adult ADD and insurance, in general? Both are things that are very new to me.

Thank you.

posted by anonymous to health & fitness (5 answers total)

My husband had a six-month timeout when switching to my insurance since his ADD was pre-existing. He only sees the doctor once every few months to re-up his scrip, so we just paid cash for that. His medication was covered immediately under my prescription plan.

Most doctors have a completely different price scale for cash patients. You will need to spend some money, but it should be pretty reasonable. It's a shit situation, but this isn't an especially high-maintenance medical issue so you should be able to keep your costs down. And you may not run into the problem; things are in flux with regard to pre-existing conditions these days.

I say go ahead on your parents' insurance now, anticipate a gap in coverage when you switch to your own. But since you'll already be mid-treatment, it'll be easier to work with your providers to handle things during that time.
posted by Lyn Never at 7:06 PM on June 23, 2012

Self-pay for mental health sorts of things that are unlikely to be complicated is not as daunting as it sounds. My pdoc is $60/visit, out of pocket; the last health insurance I had, my copay was $40 for a specialist. Usually preexisting conditions on group plans aren't barred completely, there's just a waiting period, or that was my experience, anyway. On individual plans, the results can vary a lot more, but if you're only looking at the need for maintenance medication by then, it might not be nearly as expensive as you think. And that's if you really need a psychiatrist, by then; a lot of people just get refills from their GP.
posted by gracedissolved at 7:33 PM on June 23, 2012

I don't think it being a preexisting condition will be a problem as much as prior authorization from your insurance company. I was "diagnosed" you could say with ADD from a D.O. who is my PCP not a physiologist nor do I see one.. so I can't see how your insurance would differ it from any other maintenance medication for an ailment. In the long process of finding the right medication for my ADD I was required by my insurance United Healthcare to get my doctor to assert that I needed the medication with some formality between them the insurance company and my pharmacist. All in all it cost around $50 every time and took about two weeks. Good luck with your condition and remember to ask for generic equivalents because the market is saturated with them.
posted by isopropyl at 8:31 PM on June 23, 2012

Things will undoubtedly go flawlessly if you wait until you move over, but this isn't something like MS or epilepsy that most insurance companies would really balk at. It's a bottle of pills a month and, once you're rolling, a specialist visit every so often (I'm down to once a quarter, personally). Still, YMMV based on your plan/company. I'd say talk to your PCP about it.

Also: how close are you to switching over? It took me two full months to sit down with a psychiatrist after I'd made up my mind to get tested. If you're getting close to that window, this is a non-issue.

Here is a related thing I can tell you, from my own experience, though: If you sign up for life insurance, there's an even-money chance that they'll try to tell you that your ADHD diagnosis means you have to pay higher rates, which you may confidently tell them to shove up their asses. Not all companies try this. Those who do claim ADHD puts you in a higher-risk category, but that's only the case if you have a record of addiction or high risk-taking behavior or other co-morbidities. ADHD alone means shit.

My wife and I personally fought this on a life insurance policy, researched it and sent a formal letter to the company using fancy medical terms like "co-morbidities", and basically let them know that we knew that there were plenty of other companies who would be happy to have us They practically rolled over and offered their bellies.
posted by middleclasstool at 10:06 PM on June 23, 2012 [1 favorite]

It depends. And it may change depending on what happens with Obamacare(US Health Insurance reform). I had seamless coverage when I went from Cobra'ed health insurance with Company A to health insurance with Company B. Seamless may be required under Obamacare, as it should be. If Obamacare is overturned by the Supreme Court, who knows.

You can negotiate with insurance companies. Every state has an insurance commission, and a consumer advocate's office. They're under the attorney general, and you can look them up on the web. The insurance commission for your state should be able to answer this for you.
posted by theora55 at 1:29 PM on June 24, 2012