Monday, February 27, 2012

Getting a diagnosis: Part Two

Part one is here.

I spent several hours last week dealing with doctors and insurance companies. We called to schedule the testing that Cooper's pediatrician recommended. The highly regarded specialist in our town who does this testing with children doesn't take our insurance. If we want to have it done anyway, it's $2600 out of pocket. Goodbye plans to fence the backyard this summer.

So, I called my insurance company and asked if there was someone in-network who performed these services. They put me on hold for a while and then told me that they don't cover that procedure at all until ADHD has been ruled out as a diagnosis. So, I have to get ADHD ruled out before they will authorize anyone to perform the examinations. It doesn't matter if ADHD is co-occuring with other disorders, they won't authorize it at all at this point.

So they send me back to their website to pick a provider to do a psych eval to determine if Cooper has ADHD. I finally found one person who specializes in psychiatric diagnostics rather than in counseling, and he can't get Cooper in until the end of April.  The specialist I was referred to could have gotten him in this week.

To make this even more fun, my insurance ends when I resign this summer, and we'll be switching to GeekBoy's insurance. GeekBoy's insurance covers this procedure with no hoops to jump through. But we can't swap to his insurance unless there is a "life change" like loss of insurance coverage someplace else. But I can't voluntarily terminate my insurance so we can get on his insurance.

At this point, I'm seriously considering just trying Cooper out on medication, and waiting until August when we are on the new insurance to get him properly assessed by a specialist, rather than paying for an ADHD diagnosis twice.

Things like this are why I support single payer health insurance.


Not Jenny said...

The hoops you have to jump through to get healthcare boggle my mind. I couldn't imagine. You are doing so well and I hope you can figure out how to get the answers you need. I wish I could share my Universal Health Care with you.

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