First, you want to make sure that your medical insurance includes mental health benefits. You can find this information by reviewing the materials that came with your policy, visiting the insurer's website, or calling a customer service representative at the insurance company. Make sure that when you speak with a customer service representative, you get the information in writing - via e.mail, letter, or fax.
When you file an insurance claim for your evaluation or other appointments with your clinician, your clinician fills out a claim form. A diagnosis will be listed on the claim form because insurance companies require a diagnosis in order to pay a claim.
If your clinician has diagnosed you with ADD, you may see something like "314.01 attention deficit hyperactivity disorder, combined type" either written or circled on the form you take to the office's checkout counter. The number "314.01" is a code in the DSM-IV.TR (2000) that clinicians use when diagnosing. You have the right to ask your clinician what diagnosis he is putting on the claim form if he has not told you already.
Be aware that any time you file a medical insurance claim, including claims for your visits to the clinician, that information is filed with a clearinghouse called the Medical Information Bureau (MIB). MIB states that the purpose of the bureau is to help prevent insurance fraud, but the claim information in your file may cause insurers to turn you down for medical, disability, or health insurance in the future. This is because the insurance company may deem you too risky to cover due to your past claim history - meaning that insurers may determine that you will wind up costing them more money than you pay for your insurance. Adhd And Insurance Coverage
Because of issues that may arise, some patients choose to pay out of pocket when they see their clinician. This means they pay the full amount of their bill and do not file a claim with their medical insurance. While this may be a financial hardship for you, it does mean that no record of your visit will be in the MIB database. You do have a right to see the claims information that MIB has in your file.
WHEN YOU ARRIVE AT THE APPOINTMENT
When you arrive at the clinician's office (or even beforehand), you will be asked to fill out some forms. These forms will ask you for your name, address, and general identifying information. You may also be given a consent form that explains your rights as a patient and includes the office's policies, such as information about making payments and scheduling appointments.
If the clinician's office files medical insurance claims, you will be asked to provide the insurer's contact information along with your medical insurance card so that the office can scan it or make a copy. The office may also have you fill out questionnaires about your current symptoms and medical history.
DURING THE APPOINTMENT
Now you are sitting in your clinician's office. What should you expect? The clinician will ask questions about your history of ADD symptoms and possibly alcohol, nicotine, and drug use as well as your family history of mental health. You may also be asked to complete some assessments to further help the clinician make a determination or diagnosis. Finally, questions may arise in your own mind during your appointment.
Questions AboUt Alcohol, Nicotine, or Drug Use
Your clinician may ask about your current and past use of alcohol, nicotine, and drugs. Answer these questions truthfully, because your clinician may want to prescribe different medications if you have a history of abuse or addiction. Remember, clinicians have heard it all before. Very little that you say can shock them. If you do feel upset about a clinician's response, address that with her. Remember, if things don't "click" with that particular clinician, you can always go to another.
As mentioned, it is recommended that you bring your pill bottles with you as your doctor may also ask you what medications you are taking as well as how much and how often. The pill bottle label provides most of the information your doctor needs; you may also be asked what benefits and side effects you may have from your medications.
If you feel uncomfortable answering any of the clinician's questions, tell her your concerns. Remember, however, the questions the clinician asks are a way for her to better understand you and your life experiences in order to make a more accurate diagnosis. Because there are no definitive tests for ADD like there are for other medical disorders, the diagnosis is subjective. This means that your clinician's diagnosis is at least partially dependent on the information you provide. Adhd And Insurance Coverage
Family History
Because ADD and other mental health disorders are genetic, your clinician may ask you for your family's history of mental health issues. For clinicians, family members fall into two categories: first-degree and second-degree relatives.
First-degree relatives are those most closely genetically related to you - your parents, your siblings, and your children. Second-degree relatives include your grandparents, aunts, uncles, and cousins.
Before your appointment, ask your family about the following mental health issues in addition to ADD:
- Anxiety
- Depression
- Bipolar disorder or mania
- Schizophrenia
- Alcohol use/abuse
- Any psychiatric hospitalizations
- Attempted or committed suicide
As mentioned above, keep track of this information on a notepad so you can bring it to your clinician's appointment. You want to find out from family members about relatives who were diagnosed with ADD by a clinician and also about those who were considered "off" or "different" by their loved ones. Keep in mind that if ADD runs rampant in your family, no one may notice the ADD symptoms in a relative because it seems so normal!
If you are adopted, you may not have access to information about your biological family. If you know the circumstances of your adoption or any characteristics of your biological family, every bit of information helps. Particularly important is any information you have pertaining to a possible history of ADD or other mental health issues. To find out more, you can check out Adhd And Insurance Coverage.
