Adult ADHD diagnosis - low income, semi-rural telehealth options?
September 8, 2021 9:57 AM Subscribe
I am trying to help an online friend identify some potential free or sliding-scale options to receive a likely ADHD diagnosis as an adult. The diagnosis should be portable, i.e. such that they will be able to receive treatment elsewhere without being re-diagnosed, including from state or Federal public providers.
My friend is a genderfluid queer person in their early 30s, with a low income and little to no disposable funds, and who cannot practically travel to nearby cities for treatment.
They are fairly certain that they have ADHD, and would have been diagnosed earlier in life had their parent not been opposed to it, but as such have no supporting records and would presumably require a full work-up.
They are roughly in between Kansas City and St. Louis, so I'm hoping to find some telehealth options with some kind of aid program or a sliding fee scale (ideally all the way to free, based on need) as an alternative to the people I've found in their area via google etc. I'm already aware of Openpath and have passed that info along, but even their membership and session cost may be unrealistic.
My friend is a genderfluid queer person in their early 30s, with a low income and little to no disposable funds, and who cannot practically travel to nearby cities for treatment.
They are fairly certain that they have ADHD, and would have been diagnosed earlier in life had their parent not been opposed to it, but as such have no supporting records and would presumably require a full work-up.
They are roughly in between Kansas City and St. Louis, so I'm hoping to find some telehealth options with some kind of aid program or a sliding fee scale (ideally all the way to free, based on need) as an alternative to the people I've found in their area via google etc. I'm already aware of Openpath and have passed that info along, but even their membership and session cost may be unrealistic.
Response by poster: The problem with any telehealth is that those stimulants are controlled substances, meaning they really can't be mailed or prescribed through traditional telehealth. In addition, most in-person providers can only prescribed in the state that they are registered in.
I should have mentioned I have ADHD and have been prescribed meds for it but in other states and with a well established childhood history, so, yes -- that's precisely the stuff I'm trying to sort through so they don't have to do more than make the eventual call. Their current roadblock is just getting diagnosed, so that's what I'm trying to help with (even if that's of questionable use without meds -- although I don't take meds currently, and the diagnosis is still useful to me).
It looks like a lot of psychiatrists and licensed clinicians are seeing patients remotely these days due to Covid, sometimes exclusively, but I'm unclear on how far that can go for new patients who need a script, or whether a diagnosis received in a setting like that might be questioned by other providers or public programs. Definitely appreciate the reminder that a willing primary care doc is an option, but not sure if they currently have one.
Won't threadsit further, thanks.
posted by snuffleupagus at 10:28 AM on September 8, 2021 [1 favorite]
I should have mentioned I have ADHD and have been prescribed meds for it but in other states and with a well established childhood history, so, yes -- that's precisely the stuff I'm trying to sort through so they don't have to do more than make the eventual call. Their current roadblock is just getting diagnosed, so that's what I'm trying to help with (even if that's of questionable use without meds -- although I don't take meds currently, and the diagnosis is still useful to me).
It looks like a lot of psychiatrists and licensed clinicians are seeing patients remotely these days due to Covid, sometimes exclusively, but I'm unclear on how far that can go for new patients who need a script, or whether a diagnosis received in a setting like that might be questioned by other providers or public programs. Definitely appreciate the reminder that a willing primary care doc is an option, but not sure if they currently have one.
Won't threadsit further, thanks.
posted by snuffleupagus at 10:28 AM on September 8, 2021 [1 favorite]
You can call pharmacies near your friend and ask them if they accept prescriptions for controlled substances from telehealth providers. Depends on what Missouri allows.
A diagnosis and prescription from a telehealth provider is not less valid than an in person diagnosis.
posted by jello at 11:24 AM on September 8, 2021
A diagnosis and prescription from a telehealth provider is not less valid than an in person diagnosis.
posted by jello at 11:24 AM on September 8, 2021
The helloahead website has one telehealth option where the diagnostic conversation costs $150 and medication costs $75 a month; the Done website has a similar but slightly more expensive deal.
posted by hungrytiger at 12:05 PM on September 8, 2021
posted by hungrytiger at 12:05 PM on September 8, 2021
Best answer: Controlled substances can be prescribed via telehealth. They cannot be mailed via online pharmacies, but the doctor can prescribe it and then send it to a pharmacy near you. I am not aware of any pharmacies uniformly denying prescriptions made by telehealth providers because they are telehealth. The pharmacy doesn't know how you saw the doctor when they get the prescription from the doctor. I guess it's possible but I'm not sure how it would be enforced. However, providers typically can't prescribe across state lines, so you'd have to find someone in the state.
If your friend has a GP who is willing to assess, this will be the fastest and cheapest, with the trade-off of a less rigorous diagnostic process--typically a couple of questions and maybe a short self-report form. The next least-expensive option would be a visit with a psychiatrist. Psychiatrists typically assess via an hour-long interview and some longer self-report forms, which can be done via telehealth. Psychologists typically assess the same way but often add some cognitive testing and computerized measures of attention, some of which may need to be be done in-person; this will be more expensive. Neuropsychologists would be the most expensive and involved, usually requiring 4-6 hours of testing, most of which cannot be done telehealth. Psychologists and neuropsychologists also can't prescribe medication, so your friend would need to see a GP or psychiatrist after anyway. For people who do not have complicated histories/presentations to disentangle, a psychiatrist visit is a good middle ground between expense and depth of the assessment.
Telehealth isn't a factor in whether or not the diagnosis will be considered valid, and diagnoses are always portable as you can always request your medical records should you need to prove it to another doctor. Frankly, medical professionals rarely look at more than the diagnosis code and official letterhead, so they're unlikely to even know the assessment was conducted via telehealth. If your friend is diagnosed by a GP, it is possible that a psychiatrist or psychologist later may consider that insufficient and ask your friend to undergo more testing, but this is very unlikely and I've never actually heard of it happening.
Regarding affordability, you didn't mention whether your friend has insurance or not. If your friend has not applied for Medicaid, they should do so immediately. If they apply and are not eligible, they should look at Healthcare.gov. Due to Biden's increase in subsidies, some insurance plans--even very good insurance plans--cost $0 for low-income-but-not-Medicaid-eligible folks right now. I currently pay nothing for health insurance and my meds cost $5 even before the (very low) deductible is met. The cost of meds, if applicable, will be a long-term concern, so I would have them look into this.
Whether they are insured or not, their best bet is probably to find a hospital with a financial assistance program who also provides telehealth psychiatry visits. Most hospitals have a financial aid program but you have to look for it and apply yourself, they rarely tell you up front about it. They provide discounts for low-income people, sometimes entirely free care. For example, SSM Health in St. Louis provides a 100% discount to people below 200% of the poverty level (income of $25,760 for a household of one), with sliding scale discounts as income goes up from there (e.g. 80% discount up to 250% of the poverty level, 60% up to 300% of the poverty level, etc.). They also provide telehealth psychiatry visits.
There may be other options, that was just the first result for "St. Louis hospital." I would search the name of each hospital in the area with the term "financial assistance" (or, if that doesn't work, "charity care") and look for their financial assistance policies. Once your friend has found one that looks like it will cover them, they should check if the hospital provides telehealth psychiatry visits--they may need to call to find this out. Your friend may need a referral from a GP--this depends on the provider, as well as your friend's insurance. If a GP referral is absolutely required and they don't have one, then they should look for a GP at one of these hospitals and apply for the financial assistance policy so that it can cover the cost of the GP visit as well.
Tldr; Try the GP first if there is one; Medicaid or Healthcare.gov if they don't have health insurance; if no GP or GP is unwilling to assess then see a psychiatrist at a hospital that offers financial assistance/charity care and telehealth psychiatry visits (whether they are insured or not). Good luck to them!
posted by brook horse at 1:04 PM on September 8, 2021 [5 favorites]
If your friend has a GP who is willing to assess, this will be the fastest and cheapest, with the trade-off of a less rigorous diagnostic process--typically a couple of questions and maybe a short self-report form. The next least-expensive option would be a visit with a psychiatrist. Psychiatrists typically assess via an hour-long interview and some longer self-report forms, which can be done via telehealth. Psychologists typically assess the same way but often add some cognitive testing and computerized measures of attention, some of which may need to be be done in-person; this will be more expensive. Neuropsychologists would be the most expensive and involved, usually requiring 4-6 hours of testing, most of which cannot be done telehealth. Psychologists and neuropsychologists also can't prescribe medication, so your friend would need to see a GP or psychiatrist after anyway. For people who do not have complicated histories/presentations to disentangle, a psychiatrist visit is a good middle ground between expense and depth of the assessment.
Telehealth isn't a factor in whether or not the diagnosis will be considered valid, and diagnoses are always portable as you can always request your medical records should you need to prove it to another doctor. Frankly, medical professionals rarely look at more than the diagnosis code and official letterhead, so they're unlikely to even know the assessment was conducted via telehealth. If your friend is diagnosed by a GP, it is possible that a psychiatrist or psychologist later may consider that insufficient and ask your friend to undergo more testing, but this is very unlikely and I've never actually heard of it happening.
Regarding affordability, you didn't mention whether your friend has insurance or not. If your friend has not applied for Medicaid, they should do so immediately. If they apply and are not eligible, they should look at Healthcare.gov. Due to Biden's increase in subsidies, some insurance plans--even very good insurance plans--cost $0 for low-income-but-not-Medicaid-eligible folks right now. I currently pay nothing for health insurance and my meds cost $5 even before the (very low) deductible is met. The cost of meds, if applicable, will be a long-term concern, so I would have them look into this.
Whether they are insured or not, their best bet is probably to find a hospital with a financial assistance program who also provides telehealth psychiatry visits. Most hospitals have a financial aid program but you have to look for it and apply yourself, they rarely tell you up front about it. They provide discounts for low-income people, sometimes entirely free care. For example, SSM Health in St. Louis provides a 100% discount to people below 200% of the poverty level (income of $25,760 for a household of one), with sliding scale discounts as income goes up from there (e.g. 80% discount up to 250% of the poverty level, 60% up to 300% of the poverty level, etc.). They also provide telehealth psychiatry visits.
There may be other options, that was just the first result for "St. Louis hospital." I would search the name of each hospital in the area with the term "financial assistance" (or, if that doesn't work, "charity care") and look for their financial assistance policies. Once your friend has found one that looks like it will cover them, they should check if the hospital provides telehealth psychiatry visits--they may need to call to find this out. Your friend may need a referral from a GP--this depends on the provider, as well as your friend's insurance. If a GP referral is absolutely required and they don't have one, then they should look for a GP at one of these hospitals and apply for the financial assistance policy so that it can cover the cost of the GP visit as well.
Tldr; Try the GP first if there is one; Medicaid or Healthcare.gov if they don't have health insurance; if no GP or GP is unwilling to assess then see a psychiatrist at a hospital that offers financial assistance/charity care and telehealth psychiatry visits (whether they are insured or not). Good luck to them!
posted by brook horse at 1:04 PM on September 8, 2021 [5 favorites]
As an aside, the relationship between prescriptions for stimulants and telehealth is somewhat location-dependent.
posted by crunchy potato at 5:00 PM on September 8, 2021
posted by crunchy potato at 5:00 PM on September 8, 2021
A note I'd like to add (apologies if I missed it) is that it's not so much whether telehealth providers can or cannot prescribe, it's whether they will or not. The telehealth providers connected to my insurance will not (and actually [for Reasons] my PCP who sees me in person also will not) diagnose certain disorders nor prescribe certain types of medicines. The trick is finding someone who can and will do this, not just the format. Telehealth programs will probably be the most explicit about this, but finding a PCP or other practitioner who is accepting new patients remotely and is transparent about potential limits in the care they provide may be tricky and time consuming.
Sorry OP, I wish had more specific advice.
posted by sm1tten at 7:33 PM on September 8, 2021
Sorry OP, I wish had more specific advice.
posted by sm1tten at 7:33 PM on September 8, 2021
Sm1tten is correct, and just to clarify my comments, this is why it's good to check with their GP if they already have one in case they're someone who's willing to assess/prescribe, but not worth searching for a new GP specifically for this because GPs are hit-or-miss on whether they're willing to assess/prescribe for ADHD. A psychiatrist is your best bet at finding someone willing to both assess and prescribe (as psychologists can only assess and not prescribe).
However, some may not be willing to prescribe over telehealth, not necessarily because they're concerned you're "not really ADHD", but if you have physical risk factors that they may want to monitor (such as high blood pressure or heart problems, which can be worsened by stimulants). It will depend on the doctor's practices and your friend's specific situation; again, though, the diagnosis will be valid regardless of whether it's telehealth or not.
posted by brook horse at 8:04 PM on September 8, 2021
However, some may not be willing to prescribe over telehealth, not necessarily because they're concerned you're "not really ADHD", but if you have physical risk factors that they may want to monitor (such as high blood pressure or heart problems, which can be worsened by stimulants). It will depend on the doctor's practices and your friend's specific situation; again, though, the diagnosis will be valid regardless of whether it's telehealth or not.
posted by brook horse at 8:04 PM on September 8, 2021
I use Klarity Health for ADHD diagnosis and stimulant prescriptions. They call in the prescription to my local Walmart pharmacy but will also mail the pills if needed. The initial intake video chat is $149; thereafter it is either $59 a month if you need to speak to a provider or $25 a month just for the prescription refill. I'm in Florida and coverage varies by state obviously - I don't know about your friend's area. So far the process has been painless and straightforward. Would recommend.
posted by storminator7 at 12:03 PM on September 9, 2021 [1 favorite]
posted by storminator7 at 12:03 PM on September 9, 2021 [1 favorite]
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The problem with any telehealth is that those stimulants are controlled substances, meaning they really can't be mailed or prescribed through traditional telehealth. In addition, most in-person providers can only prescribed in the state that they are registered in.
Now, a primary care physician can also diagnose ADHD. You could do that as part of your annual physical that you get free with insurance. And then, for the pills, you can use GoodRX to get them at a huge discount (I've found GoodRX + costco is best, better than expensive health insurance rates).
In researching this topic, my favorite blogger has done VERY HELPFUL articles about what stimulants are, why they help, side effects, etc.
Know your amphetamines
A bit about why it's hard being a psychiatrist because everyone wants adderall
An Up to date guide on the drug on his website
You could also consider his sliding scale telehealth program, it's here: https://lorienpsych.com/become-a-patient/. Seems very fair in terms of money.
posted by bbqturtle at 10:05 AM on September 8, 2021 [5 favorites]