Getting Out-of-Network Insurance Reimbursement on your ADHD Diagnosis Appointment

The Costs of ADHD Care

ADHD treatment is a major money-maker in the healthcare world. A report by Grand View Research found that the global market value for ADHD was $16.4 billion in 2018. That number is striking, but there's good news for people who need ADHD care. Insurance often helps to cover the costs on an individual level.

Getting insurance coverage for ADHD treatment is important since it often involves a lot of moving parts, such as:

Initial assessment and diagnosis
ADHD medication
Therapies to help with ADHD management

The costs for ADHD care can add up quickly. In a 2012 study in the Journal of the American Academy of Child and Adolescent Psychiatry, annual costs for ADHD care were estimated at $2,720 per person for children and $4,120 per person for adults. Another survey found that the average costs for ADHD medication alone were $935 and $735 for children and adults, respectively.

At Done, we never want costs to keep someone from getting the care they need. In addition to our affordable services, we make it as easy as possible for patients to file claims with out-of-network insurance providers. When you minimize the financial burden, you'll be better able to focus on your ADHD care.

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‍What Are Out-Of-Network Claims?

‍Out-of-network claims are forms submitted to your insurance provider to process possible reimbursement of medical services provided by practices that are not contracted with your insurance.

ADHD is typically classified as mental health care by insurance providers. But every insurance policy is different when it comes to coverage. Some will cover mental health care, while others may not. It is important to read your insurance provider's policies carefully to understand what they do or do not cover.

‍What Kinds of Insurances Process Out-Of-Network Claims?

‍PPO and indemnity plans might cover some portion of the cost of your initial consultation or membership fees. You'll know if your insurance might cover some portion of your bill if you have a network of doctors to choose from rather than your insurance assigning a doctor or facility to you, with no coverage outside of that assigned doctor or facility.

HMO and EPO plans will only cover the costs of doctor's visits for one doctor or facility and therefore will not cover services through Done. You should contact your insurance company or benefits manager if you have any questions regarding your insurance.

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How to Get Your ADHD Diagnosis Appointment Reimbursed by Your Out-Of-Network Insurance Provider

Now that you know the basics about insurance coverage for ADHD, it's time to submit your claim. Here's a step-by-step guide to walk you through the process.

Step 1: Download your Superbill

Done makes it really easy for you to access the Superbill for your initial ADHD diagnosis assessment. All you have to do is download your Superbill PDF from your Done patient portal. Fill it out with the requested information. If you have any questions along the way, don't hesitate to reach out to us. We're here to help you get insurance coverage whenever possible.

Step 2: Submit your claim

You can submit your out-of-network insurance claim online or through the mail. To submit your claim online, go to your insurance provider's website and log in to your insurance member portal. Search for the "Submit a Claim" section of the member portal. Don't forget to upload your Superbill PDF when you are submitting your reimbursement claim. Online submission might not be available for all carriers, but if you cannot find the online option, you can always contact your insurance provider directly for help.

After your insurance provider reviews the claim, you can expect an Explanation of Benefits with a possible check in the mail 30 days after the claim is submitted. Of course, it depends on your insurance provider whether they will reimburse your appointment or not, as well as the amount that will be reimbursed. It is important to note that reimbursement requests may take several weeks and will be completed and paid out by your insurance company.

Step 3: File an appeal if necessary

What if your claim is rejected? Don't give up hope just yet. There are independent review boards in most states with which you can file an appeal if your insurance claim is denied. If it comes to this step, the more written documentation you can provide, the better.

The appeals process can take some time, but it may be well worth it to pursue. In fact, a study by the Kaiser Family Foundation found that 52% of patients win their first in-house appeal.

ADHD is not curable, so ongoing treatment is essential. That's why it's so important to take advantage of your right to appeal if your claim is initially denied. If you have any questions about your coverage, get in touch with your insurance provider to learn more.