How can I afford to treat my ADHD?
March 3, 2008 12:25 PM   Subscribe

I am trying to figure out how to get treatment for my ADHD, but I am afraid that if I see a doctor now then I won't be able to afford treatment in the future... please help me understand my options, and how co-pays work! It's a bit long inside, sorry!

A little context: One summer in college I read a book about ADHD and realized that I was a pretty classic case. I found a psychiatrist who agreed with me, and I took Concerta for my senior year, and it made a huge difference. My GPA went up about 0.7 points, my life was more organized than ever before, and things were good. After college I worked a variety of jobs, including a couple years out of the country (that country being the USA), and I stopped taking Concerta. I was mainly teaching, and I did ok without the pills, but I am back in the States, working in an office, and I am finding that my ADHD symptoms are again a real problem in my life.

I am currently working as a temp, and I pay for my own private insurance, which is a very high-deductible policy that I've never used at all (had it for about 6 months). I don't know what my office visit co-pay is, or even where the documentation for the policy is (big surprise, I know). There is a clinic down the street from my apartment that does sliding scale appointments, which could be very helpful as my budget is pretty tight as it is.

Ok, so I guess the meat of my question is this: if I go see a doctor now and get a prescription, then when I get new insurance in the future will I have to pay the full cost of ADHD-related office visits, or just co-pays?

I figure that my (hypothetical) future insurance wouldn't cover the prescription costs (as it would be a preexisting condition). But if you haven't received treatment for something in a while, that's usually not counted as preexisting, right? My last Concerta prescription was in May of '04.

Generic Ritalin is super cheap ($4/month at Walmart!), so the cost of the pills is not a big deal. However, methylphenidate is a Schedule II drug, so I'll need to get a new prescription every month, so those office visit fees could be really onerous if I were charged $150 or whatever it is a doctor's visit costs these days.

Thanks so much for reading, I am very interested to hear anyone's thoughts on this!
posted by allen8219 to Health & Fitness (7 answers total)
For new insurance, it would depend on their policies.. And whether the Dr. takes that insurance.. When I've changed insurances they generally pay or mostly pay for my prescriptions (I take Lexapro, Advair, and Allegra and those are all for preexisting conditions).. But obviously since we don't know about your new insurance it's impossible to know..

Some doctors might give you new prescriptions without a visit every month.. (My mother takes Wellbutrin and her regular doctor (actually a Nurse Practitioner) gives her prescriptions for that.. but it's not a Sched II drug)

Hope it helps!
posted by majikstreet at 12:38 PM on March 3, 2008

Well, you already have a record of preexisting ADHD from the year you took Concerta, so I don't think treatment now will make any difference in that regard.

You're in the states now? If you can get group coverage there are usually no exclusions, exen for pre-existing conditions. If you have to buy an individual policy in the future ... I don't know.
posted by robinpME at 12:40 PM on March 3, 2008

First find out what your current policy is. If you have a high deductible, then you may have to the full cost of the visit (not just the co-pay) until you reach the deductible. Second, as long as you have continuous coverage, pre-existing conditions are only a problem if you move to a new individual plan (with HIPPA, you should be OK with a group plan). The exclusion for pre-existing condition is usually for a year or two, so your previous treatment would probably not be relevant. (Of course, you always have to find read the fine print since your situation may vary)
posted by metahawk at 1:02 PM on March 3, 2008

If the doctor's office accepts assignment then you will have to pay the approved amount of whatever they billed. As for your future insurance, if it is a company group policy, you should not have any pre-existing problems. I would advise you to call about and see the cash pay prices in your area. They can vary. Also, just because you have to be on a schedule II drug you may not have to see the doctor every month. Maybe every 3-4 months. This depends on the doctor in question. I know of some in our area that will prescribe for 6 months or more. The doctors that I work for usually like to see their patients every 3-4 months.
posted by JAD'E at 1:16 PM on March 3, 2008

Response by poster: Very interesting, thanks everyone!

JAD'E, I will call around like you suggest... I forgot about cash prices vs. non-cash, I can definitely pay upfront to save, which could be great in my case.

I think that my current insurance is pretty much crap, I really only have it in case I get hit by the proverbial bus (though a classmate of mine got hit by an all-too-real bus, so it does happen). Hopefully this low-cost clinic will be able to give me an appointment for a non-exorbitant fee... I think just writing this question was important for me mentally, in terms of actually doing something about my problem instead of just stewing and waiting.
posted by allen8219 at 1:33 PM on March 3, 2008

I don't have very much experience with this type of thing, but I've heard that ADHD can, in some cases, be controlled to some degree by a change in diet. Might be worth looking in to.
posted by ChazB at 1:50 PM on March 3, 2008

Minor clarifying point, if ADHD-like symptoms can be controlled with diet, then it's not ADHD.

In answer to your question, visit with the staff where your prospective doctor works and explain your situation. They ought to be able to give you sane pricing based on your high deductible. For example, my deductible is $250. So the docs charge full freight for the first few visits because they know that the rest of the year, they're only getting the $47 per visit the plan covers.

My own theory is that its worth every penny I spend on health and mental health services because they allow me to be at my personal best. It's an investment that shows its returns in increased productivity and more earnings.
posted by gjc at 5:44 PM on March 3, 2008

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