Does Insurance Cover ADHD Testing and Treatment? Guide for Assessment
Does insurance cover ADHD testing? Explore the available coverage, how much ADHD testing costs, and best practices for getting insurance coverage.
Key takeaways
Testing plays a crucial role in the lives of the millions of people in America living with attention-deficit hyperactivity disorder (ADHD). While people with ADHD may struggle with impulsivity, experience certain memory-related problems, or have difficulty staying on task, treatment can help them manage their condition and ultimately thrive. To access treatment, they’ll first need to receive a diagnosis from a qualified healthcare professional. How does a doctor arrive at such a diagnosis? You guessed it: Testing.
By testing, we mean a process of screening and evaluation from a licensed professional. No online test can diagnose you with ADHD or any other condition. Screening is a preliminary consultation that helps clinicians discern if a person at risk of having ADHD should undergo further evaluation. Don’t let the word “evaluation” spook you – it just means that a clinician will ask you questions about what’s going on with you and what effect that may be having on your life. They’ll make observations based on your answers and may also gather information from people who know you well, all in an effort to provide you with an informed diagnosis.
If you think you might have ADHD and want to pursue screening and evaluation, you’ll first want to determine if your health insurance covers them. The answer: It depends. A variety of factors – including your location, your provider, and the specific policy you have – can affect whether and how your insurance will pay for ADHD assessments. Keep reading to learn more about ADHD testing, insurance coverage and tips, potential costs, and more. We’ll finish by discussing Talkiatry’s approach to ADHD care.
What Is an ADHD Test?
There’s no one, single test for ADHD, but broadly speaking there are three types of testing, which may be used independently or in concert.
- Clinical Interviews: In assessing you for ADHD, a psychiatrist may conduct clinical interviews with you to learn more about your behavior in various settings. They may also ask permission to speak with friends, family, partners, and, if you’re not an adult, schoolteachers. They’ll examine your medical history, too.
- Behavioral Assessments: Other options include standardized behavior rating scales and symptom checklists, which your physician can use to determine if you meet the basic criteria for an ADHD diagnosis.
- Neuropsychological Testing: In certain cases, a physician may decide that a patient would benefit from a series of neuropsychological tests that can help clarify the patient’s diagnosis.
Why Is ADHD Testing Important?
People with ADHD may have trouble functioning at work, maintaining relationships, and managing their day-to-day life. Testing for ADHD can result in a diagnosis and, thus, can grant patients access to treatments that in turn can help them thrive.
Medication Access
Stimulant and nonstimulant medications are frequently prescribed to people with ADHD as part of their treatment plan. How will your psychiatrist determine you're diagnosed with ADHD and may benefit from medication as part of your treatment? That’s right: clinical evaluation.
Therapy Access
Testing can also clear the way for you to receive cognitive behavioral therapy (CBT) – which helps patients change unhealthy or unwanted behaviors and thought patterns – or another form of therapy. Therapy may be used alongside medications or, in some cases, as a standalone treatment for ADHD.
Effective Management
If you combine access to medication with access to therapy, what do you get? The opportunity to effectively manage your ADHD symptoms. And it all starts with getting evaluated.
Does Insurance Cover ADHD Testing? Key Insights
The short answer is that most insurers cover ADHD assessments for adults and children, but it’s important to check with your particular insurer. Your coverage may vary based on which plan you have with your insurer. Also, your insurer may cover testing with some providers but not others. Additional factors, like your particular medical needs, may also come into play. Heads up, this is going to be a running theme going forward: When in doubt, check with your insurance company!
Type of Insurance That May Cover ADHD Testing
- Private Health Insurance: If you purchase health insurance from the marketplace, consult your plan or a representative for information about ADHD testing coverage.
- Employer-Sponsored Plans: Get your health insurance through work? Review your benefits to determine whether and how ADHD testing is covered.
- Medicaid: Coverage may vary by state, so it’s worth reviewing your plan to confirm that it covers ADHD testing.
- Medicare: If you have Medicare, consult a plan representative, your provider, and/or the plan itself to learn what kind of testing may be covered.
How Much Does ADHD Testing Cost?
We’ve said that most insurers cover ADHD testing, right? And it’s your insurer who’ll ultimately be best able to inform you how much that testing could cost. Depending on your insurance plan, you may be responsible for copays, coinsurance, or a deductible.
A copay is a flat fee – often around $15 or $30 – you pay for covered healthcare under many insurance plans. Some plans also have a cost-sharing feature called coinsurance, where you and the insurer each pay a set percentage of the total cost of a medical visit. Your deductible, meanwhile, is the set amount you’re required to pay towards covered medical costs annually before your insurance properly kicks in and begins picking up the bill. Talk to your insurance company (or read about your plan) to learn which of these may apply to your situation.
Tips to Get Insurance Coverage for ADHD Testing
- Understand your insurance coverage policy: Give your company or provider a call (or review the plan yourself) to figure out what it covers for ADHD and whether you have a relevant deductible, copay, and/or other costs.
- Request pre-authorization if required: Some plans require a doctor or patient to request approval for testing (or treatment) before initiating it. Check with an insurance rep, your doctor, or both for more info.
- Get a referral from a primary care doctor: Your insurance company may only cover ADHD testing if you’ve gotten a referral from your primary care physician. Again: ask your insurance company about referral requirements. If you do need a referral, ask your doctor for one.
- Ask about reimbursement for out-of-network assessments: We might sound like a broken record at this point, but it bears repeating that you should consult your insurance company! Specifically, if you’re seeking an ADHD assessment from an out-of-network provider, ask a representative for specifics on their reimbursement policies.
- Appeal if necessary: Denied reimbursement? Denied coverage? Sometimes insurance companies get things wrong. Talk to your insurer and consider filing a formal appeal.
Is ADHD Treatment Covered by Insurance?
When we ask whether health insurance covers ADHD treatment, we’re actually asking a few different questions. Does it cover medications? Does it cover consultations? Does it cover talk therapy? While most insurance plans cover ADHD treatment, the precise answers to these questions can vary depending on your plan.
If you’re not sure what your insurance company will cover, try looking on their website for information or giving them a call. Check to see if you need to get that referral or pre-authorization from your primary care physician before your plan will cover treatment. It’s also a good idea to find out if you have a copay or deductible that could factor into the total cost of care.
Talkiatry: Expert ADHD Care, Covered by Insurance
At Talkiatry, we accept a wide range of insurances, including some medicare plans, because we believe that quality mental healthcare – for ADHD and other conditions – should be affordable and accessible. Not to mention convenient: our virtual appointments mean you won’t have to spend time commuting to see your doctor.
And who will your doctor be? After you complete our quick intake questionnaire, we’ll work to pair you with one of our 600+ psychiatrists best suited to your specific needs. Your psychiatrist will in turn work with you to develop an appropriate treatment plan. If you’re diagnosed with ADHD, that may include stimulant medications, nonstimulant medications, and/or therapy. You can learn more about our approach to treating ADHD here.
FAQS on Insurance Coverage for ADHD Testing
How do I check if my insurance covers ADHD testing?
Review your plan, talk to an insurance representative, and/or consult your provider to determine what kind of ADHD testing coverage your health insurance provides. Inquire about possible copayments, coinsurance, and your deductible, which could affect testing costs. Also, ask if you need a referral from your primary care doctor or prior authorization for your insurance to cover testing.
What if my insurance denies ADHD testing coverage?
You can start by getting in touch with your insurance company and filing a formal appeal if needed. Some providers may also offer lower-cost, sliding-scale services for people whose insurance refuses to cover testing.
How do I start ADHD treatment after getting diagnosed?
If you’re diagnosed with ADHD,, you’ll work with a psychiatrist to figure out the optimal treatment plan based on your individual needs. This may include medications, a form of therapy like CBT, or both.
