$1200 for diagnosis?!?

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    • #75527


      I am a 36 year old married mom of 3, soon to be 4. I suspect I have ADD. I called a local doctor who claims expertise in this area and she told me that because of “milliman care guidelines” my insurance will not cover the costs of diagnosis. She said it would take 6 hours of questioning and 2 hours of paperwork at $150 an hour bringing the total to $1200. Is this normal? My Primary care Dr. doesn’t know much about ADD and offered to find a questionnaire for me to fill out. I assumed he wasn’t competent in diagnosing this so looked for someone more experienced. She is the first person I have reached out to. Has anyone else encountered this expensive problem? How can this be? Is there a less expensive way to be diagnosed accurately? Any help is appreciated.

    • #75583

      Hello. You live in Oregon? I’m in Massachusetts and I am an LICSW. Licensed Independent Clinical Social Worker. Diagnosis of mental health disorders is guided by the DSM-5. You can go online and use this information to see if you meet the criteria for the diagnosis of ADHD. I was diagnosed as an adult when I was in grad school. I work with people of all ages with ADHD. Females are often missed in this diagnosis, because we are more quiet and well behaved. Not climbing trees and jumping around, loud, etc.
      Here, there are checklists that can be completed by the child, teachers, and parents. These checklists are typically given to the parents from their child’s pediatrician, who distribute them to the school to be completed and then returned to the pediatrician. The pediatrician can determine if the child meets the diagnostic criteria. If the do, the pediatrician can prescribe ADHD medications. They usually start with the most common generic med and they are guided by the patient’s response to the Med and any side effects. Psych Med prescribing is done by trial and error, starting with the most commonly effective Med at the lowest dose. Then they titration the dose up if it is working and there are no adverse reactions such as headache,etc. There are many meds to try. Often a trial of a stimulant Med is used to assist in making the diagnosis or ruling it out. When you give a stimulant to a person with an ADHD brain, it has the opposite effect. The stimulant slows the brain down so the person can focus and get work down. Just like a pot of coffee typically revs a person up from the caffeine, if the trial stimulant med makes you feel revved up, then you do not have ADHD. If you have an ADHD brain, the stimulant med will have the opposite effect. It will slow you down so you can get things done. In the trial and error phase, sometimes the dose is too high, and this results in the patient being too slowed down and they can actually present with depressive symptoms. So, just as a pediatrician can treat ADHD, your primary doctor can treat your ADHD if you meet the criteria. This is because this is not a complex diagnosis and the medications are fairly straightforward. I’m not saying that the diagnosis of ADHD is not a complex disorder to deal with. This is a very challenging disorder to live with and manage.

      The lengthy test that you are describing is reserved for clients who have a very complex presentation of symptoms. Clients with multiple disorders, making the diagnosis much more difficult.

      So, you don’t need that extensive and expensive testing to be done, to be diagnosed with ADHD. GOOD LUCK!!!

      And take

    • #75633
      Penny Williams

      Yes, a private-pay evaluation can cost $1,000 to as much as over $4,000. And, many insurance policies won’t cover it.

      Sometimes, you can find programs at a university where graduate or medical students do the evaluation and that tends to be less expensive. There may also be a sliding-scale payment clinic near you.

      I think some psychiatrists may give a diagnosis after a few office visits, which may be covered by your insurance.

      ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism

    • #75777

      Dear heywhichwaydoigo
      I happen to be from Massachusetts also. I totally concur with Patrishhardy. I was diagnosed at age 39 (now 47) by my general practitioner. If your gp refuses to help you, just ask for another dr in that office. $1200 or any “extra” cost is outrageous and uncalled for. A Nurse Practitioner (who works in a Counseling office as their “med” person) confirmed my diagnosis with just a conversation. I have all the red flags! I know them so well that I can now pick out other adults who have AdD or AdHD too. We are so much alike but many people have no idea because they think it’s a “kid thing” that you outgrow. You don’t outgrow the way your brain works. Get diagnosed by a kind doctor who isn’t trying to rip you off or gouge your insurance. You will be relieved when/if your child starts to show symptoms (my two boys have it too and they struggled in the beginning but are doing much better…all on meds and under the same great doctors!). The sooner you know – the better your life will be (for yourself and your child!). This website is a gold mine of information and wonderful people! I highly recommend this book: Delivered from distraction : getting the most out of life with attention deficit disorder by Dr Edward Hallowell. Good luck to you! Your life is worth asking for a 2nd opinion!

    • #76707

      Hi there, I am in Canada here you need a psycho-educational assessment to be diagnosed. I have mine in two day, and was told that the cost will be between $800-1300 depending on how long they need to accurately diagnose me. Hopefully it doesn’t take to long.

    • #76711

      I think sometimes the long & involved expensive diagnosis is required to get school accommodations (but hopefully the student doesn’t pay for it).

      For regular folks looking for a diagnosis and meds, the cost should just be the normal cost of an appointment with a psychiatrist or an MD. In an hour, they ask you a bunch of questions and decided if they think that is the best direction to go – it can be less than satisfying, especially if the person doesn’t seem very knowledgeable about ADHD. I needed to be convinced more, so I went to a psychologist who specializes in ADHD and took home surveys for me and my family to fill out independently. Then in a second appointment, we went over the surveys and he convinced me that I had ADHD and that I had a lot to gain by understanding it better. But a psychologist can’t prescribe drugs, so then I started working with a psychiatrist (could have gone to an MD as well). The psychiatrist didn’t need to see the diagnosis from the psychologist, they did their own 1/2 hour of questions, and made sure to rule out other things like bipolar.

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