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Psychologist/Psychatrist?
September 6, 2012 7:54 AM   Subscribe

I need to see a psychologist/psychiatrist to be screened for ADD and perhaps some other stuff as I've been having issues functioning. I'd been diagnosed with ADHD as a teen. I do not have insurance and work only a part time job. Help?

I've been thinking about this for the past 6 months or so, I just haven't had the money to do it. I'm having issues that are interfering with both my school-work and work. I'm sick of feeling this way. As a teen, I absolutely hated medication and refused taking it, but I feel like my problems are finally getting in the way of living life and I want to do something about it.

I'm just afraid this kind of help is going to end up being really...really...expensive. I do everything I can to help myself, but it's no longer enough. I am bored all of the time unless I'm doing 5 things at once. I positive self-talk myself at work but I can't focus for more than a few minutes at a time because I find it really boring. I get scolded (at work) all the time because of this. Unless I find homework super interesting, I never get it done until the last second-- which is really messing up my grades. All of this is messing up my relationship and we've been fighting all the time.

What should I be looking for? I assume from what I've researched already that psychiatrists are super expensive. I do not want to waste my time with 'alternative' medicine type professionals that believe that medication doesn't help. I've been to several therapists like that in the past and they've ran their course.

How can I get the help I need both as cheap (as cheap as having no health insurance goes) and efficiently as possible? Am I going to have to see a professional multiple times? If you've been in this kind of situation, how much did it end up costing?

I live in Indiana and I am 26, if it makes a difference.
posted by camylanded to Health & Fitness (13 answers total) 2 users marked this as a favorite
 
Also, does a diagnosis expire? I would just assume they would re-screen me since things change between adolescence and adulthood. I've never really looked into it.
posted by camylanded at 7:59 AM on September 6, 2012


If you're only working part-time, are you eligible for any Medicaid/Medicaid Managed Care benefits? Here's what Indiana has to offer from what I can tell.
posted by griphus at 8:00 AM on September 6, 2012


Also, the whole hella-expensive-battery-of-tests screening is often used but generally not required for a diagnosis and prescription (at the end of the day all you need is a psychiatrist saying 'yes, you have ADHD' and handing you a prescription,) although this may depend on your state.
posted by griphus at 8:02 AM on September 6, 2012 [1 favorite]


No. Medicare is really tough to get in Indiana. I've tried. They told me I'd have to be disabled or pregnant in order to get such benefits.
posted by camylanded at 8:02 AM on September 6, 2012


Medicaid, Medcaid Managed Care and Medicare are three different things.
posted by griphus at 8:04 AM on September 6, 2012


You're in school currently? Does your university have a mental health clinic? I'd start there.

Am I going to have to see a professional multiple times?

Yes, all ADHD medications are controlled substances and they don't give you indefinite prescriptions. My husband has to see someone at least every 90 days.
posted by desjardins at 8:04 AM on September 6, 2012 [1 favorite]


Check to see if there are any community mental health clinics that operate on a sliding scale fee basis, or since you're still in school, perhaps they have someone on campus who can help. Also make clear to your doctor that you're short on cash. There may be samples of your medication available. I doubt it for an ADHD drug, but if they prescribe Ritalin, the generic form is very cheap.

As for diagnosis, it depends on your doctor. You're describing some pretty classic symptoms, tho. It helps that you were diagnosed before you were an adult. Adult-diagnosed ADHD is often discounted by doctors, IME.
posted by Meep! Eek! at 8:04 AM on September 6, 2012


I'm not going to a university-- my community college does not have anything like a mental health clinic. I'm transferring next semester but that does not help me this time around.
posted by camylanded at 8:15 AM on September 6, 2012


You can try a Centerstone center near you. They do free consultations at request. The only thing I'd keep in mind is that the majority of their programs are for substance abuse but they might be able to provide you with other options if you talk to them about your situation.
posted by dubusadus at 8:36 AM on September 6, 2012


Are you near the Indiana University School of Medicine? Medical Schools and academic hospitals generally have teaching clinics where you can be treated by residents for little or no charge.
posted by abirae at 8:40 AM on September 6, 2012


My psychiatrist charges $50 for a missed appointment, and gets $65 from my insurance company each time I see her (20-minute appointments.) Some psychiatrists will give you three written scrips at once (the pharmacies are prohibited from giving you the meds for more than a thirty day period, and my pharmacy can't give you the next fill until you're 2 days away from running out,) but that's only when you've reached the point where you know what med works, which usually takes a few visits, six weeks apart. Some psychiatrists will give you the one 30-day, and let you come in to pick up the next two from the front desk without paying for an appointment. Again, you have to be stable.

My therapist gets $40 from the insurance company each time I see her (45-minute appointments) and charges $25 for missed appointments. I think that therapy is really good as long as your ADHD is still causing trouble, but it's not absolutely vital.

Go to the nearest big university with a psychiatry program (e.g., Indiana University) - we're desperately short of psychiatrists, especially in the midwest (double-especially outside of big cities,) so this is likely to be your best shot at both "soon" and "cheap". It still won't be much of either. Ritalin is very cheap, as Meep! Eek! has indicated. My drug, Vyvanse, is not cheap at all - my insurance pays $152.81 a month for it.

If you do end up on Medicaid/Medicare/whatever, please be aware that it's actually much harder to find a psychiatrist who works with these programs than you'd like. Almost everyone I know with these programs has had to endure a lot of frustration in getting and keeping care; plenty of people I know have just flat-out been told they won't be able to see a therapist/etc., for X number of months (X = 6 or more) because of "budget cuts." None of my treatment providers take any form of public insurance, except the big-university hospital I've gone to for intensive outpatient programs. And they're the only place that takes public insurance on an emergency basis. Just a few weeks ago a new hospital opened up in town that said "we won't take public insurance, but hey, this opens up beds at places that do, right?" Community mental health places tend to be crisis-oriented: Are you experiencing psychosis? Do you have a plan to kill yourself? Okay, that's good, here's a list of people who can see you in four months.

Also, be aware that ADHD doesn't tend to get grouped with the "serious mental illnesses," and so you end up lower (in priority for getting treatment) than everyone who has bipolar disorder, schizophrenia, etc. Lots of psychiatrists just don't want to deal with ADHD, and lots more don't have the time. You're better off walking into a doctor's office saying "these are all my problems and here is how it is messing with my life, please help me. Oh by the way I had ADHD diagnosed in school." Bring your old IEP if you've got it.

I suggest you hook up with CHADD; they're the best source of "crap I need help how can I get it" advice for adult ADHD. NAMI is good for the "other stuff." Support groups are a good supplement to actual medication and therapy, but they're not nearly as good.

Also, if you have a primary care physician, start there. My PCP is actually friends with the best ADHD/bipolar/anxiety person in the city; it turns out this is really normal, because lots of doctor types all know each other and know who's good at what. They also know who's willing to quietly take on uninsured patients, etc.

By "don't have the time" and "are desperately short of psychiatrists" I mean that there was an 8-week waiting list for me to see someone, and I had 1. private insurance, 2. a referral from a respected professional in the psychiatric community, 3. a confirmed diagnosis of bipolar disorder, 4. a current severe depressive episode which had me half a step from losing my job. I was nearly suicidal at the end of June, and the "nearly" meant that I couldn't get into the IOP program until late July. I know someone who had to take an ambulance 60 miles north to get a bed in a hospital when she was acutely suicidal.

If I lose my insurance, I will probably go without treatment for a year or two, and be on disability (because boy howdy will I be disabled) and then I'll have Medicare, where I will get crappy treatment. The only good part is that I might - maybe - be able to get refills of whatever I'm currently on. I suspect my psychiatrist might be willing to write the scrips. Maybe. That route would cost me most of my income on disability unless/until I could get on the patient assistance programs. The problem is that I'm not stable, which means the likelihood of any given med working well to go on the robo-signing of refill scrips plan is very, very low. My insurance company has spent at least $20,000 on my mental health care in the last twelve months - $2,613.72 of that that was necessitated by the ADHD component, because I had to have appointments for that every single month.


If you want I can give you book suggestions. Some of them are reasonably helpful. But meds are really necessary for ADHD symptoms, in my opinion.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 8:41 AM on September 6, 2012 [1 favorite]


Look to see 1. If your County or City has a mental health program. 2. if there is a community health center, they'll be able to charge you on a sliding fee scale.
posted by thylacine at 8:42 AM on September 6, 2012 [1 favorite]


To echo Puppetman--my neurologist charges me $65 for an appointment, writes me an Rx that I fill at Costco for the generic Adderall SR (around $50 for 60) and I self-pay. Many Drs will give a discount for those who self-pay, but you have to ask. Not having insurance is not a reason to get this treated and once you find the right meds, other stuff, like work and school, usually become much, much easier.
posted by Ideefixe at 12:10 PM on September 6, 2012


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