Does Aetna Cover ADHD Testing & Treatment?

Does Aetna Insurance Cover ADHD Testing & Treatment?

Yes, Aetna insurance may be able to cover attention deficit hyperactivity disorder (ADHD) testing and treatments in Tennessee, depending on your insurance plan. Specific services for assessing ADHD are considered medically necessary by Aetna.¹

Jump to Section

• Does Aetna Insurance Cover ADHD Testing & Treatment?
• How to Verify Aetna ADHD Coverage
• What Is ADHD?
• Does Aetna Cover ADHD Testing?
• Does Aetna Cover ADHD Treatments & Medications?
• How To Find Aetna ADHD Testing & Treatment Clinics Near Me?
• How Much Does ADHD Testing & Treatment Cost Without Insurance?

How to Verify Aetna ADHD Coverage

Athena Care is in-network with most major insurance plans. Call your insurance company or contact us below to determine if your Aetna insurance of Tennessee covers ADHD testing.

Athena Care is in-network with most major insurance plans. Find out more about your insurance coverage by calling your insurance company or contacting Athena Care at 877-641-1155.

What is ADHD?

Attention Deficit Hyperactivity Disorder, or ADHD, is one of the most common pediatric psychiatric conditions. It is most commonly diagnosed in childhood and can last well into adulthood.

Adolescents with ADHD may struggle to pay attention, manage impulsive behaviors, or be extremely active.²

Signs & Symptoms of ADHD

Children who have difficulty focusing and behaving are not uncommon. Still, children with ADHD do not simply grow out of these behaviors.

The following signs of ADHD persist and can be severe, causing problems at school, home, and other social situations.

• Frequent daydreaming
• Forgetfulness
• Difficulty paying attention
• Easily loses things
• Squirming or fidgeting
• Talking too much
• Taking unnecessary risks
• Making careless decisions
• Hard time resisting temptation
• Trouble with taking turns
• Difficulty getting along with others

Does Aetna Cover ADHD Testing?

Aetna ADHD testing may be covered depending on your specific insurance plan’s benefits. When Aetna ADHD testing provides aid in assessing cognitive impairment related to medical or psychological problems, Aetna considers this medically necessary when certain criteria are met.³

To diagnose ADHD, Aetna ADHD doctors use a mix of exams, testing, and other information. ADHD doctors consult the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Fifth Edition, published by the American Psychiatric Association (APA), which contains the diagnostic criteria for ADHD. A diagnosis considers the following criteria:

• A parent/child interview is required to rule out other possible explanations of symptoms, such as environmental issues.
• Medical background – A doctor will discuss your child’s social, emotional, educational, and behavioral history.
• A physical examination.
• ADHD behavior rating scales or checklists – Parents and teachers use these to assess their children’s symptoms.

To diagnose and treat ADHD, a variety of specialists are available. Child psychiatrists, family physicians, pediatricians, psychiatrists, and neurologists are just a few examples. In addition, individual and/or family member psychotherapy may be used to treat ADHD. ADHD does not have a specific test; it’s clinically diagnosed.

Does Aetna cover ADHD Treatments & Medications?

Yes. Aetna may cover ADHD treatments and medications. Your benefit plan will determine your eligibility and the specifics of Your Aetna ADHD treatment plan and Aetna ADHD medication coverage.⁴ It’s required to show documentation of an ADHD diagnosis for most of the prescription medications used in treatment.⁵

Certain medicines are used to manage symptoms of ADHD. The American Academy of Pediatrics (AAP) recommends that children with ADHD be treated with medication and/or behavioral therapy.

Following the administration of medications, patients should be closely monitored, and medicine should be taken consistently. Then, the doctor can check to see if the patient is getting the correct dose. After a few weeks on the medication, the side effects usually fade. Alternatively, the dosage might be reduced to minimize side effects.

Medicines used to treat ADHD include:

• Stimulants⁶
  • Stimulant medications, like Adderall or Ritalin, are commonly used to treat ADHD. These medications work for people of all ages to alleviate symptoms. Behavioral changes are usually rapid and significant.
• Non-Stimulants⁷
  • If stimulant medications cause unpleasant side effects or are ineffective, a doctor may prescribe a non-stimulant medication, like Strattera. These can be taken on their own or in combination with stimulants.
• Complementary or Alternative Medicines
  • Some therapists and other health professionals employ complementary or alternative medicines. Because the peer-reviewed medical literature does not support the use of these health services for ADHD, Aetna considers them experimental and exploratory for the testing and treatment of ADHD. Therefore, Aetna may not cover such alternative medicines. However, acupuncture, for example, can assist in relieving stress and muscle tension while also improving your overall health and quality of life.

How To Find Aetna ADHD Testing & Treatment Clinics Near Me?

With Athena Care, gaining access to ADHD testing clinics in Tennessee has never been easier. A care coordinator can assist you with any questions or concerns at one of our various Tennessee locations. Athena Care health clinics are open Monday through Friday, 7:00 a.m. to 6:00 p.m.

When choosing Aetna ADHD doctors for testing and treatment, it’s important to ask questions and to keep the following in mind:

• Education, training, license, and years of experience
• Specialties and services offered
• Treatment methods and philosophies
• Insurance companies they work with
• Office hours
• Pricing
• Session length

Here, you’ll find a list of practitioners organized by city, as well as information about their backgrounds and specialties.

How Much Does ADHD Testing & Treatment Cost Without Insurance?

The following are average costs for therapy, though they may vary by location and other variables and may not reflect the actual cost of treatment or what you may pay in Tennessee.

Doctor’s visits alone can range from a few hundred dollars to more than $2,700, and the cost of medication can go anywhere from $8 to $288 per month. For example, a month’s supply of widely prescribed generic stimulants costs around $187.97.⁸

In the United States, the typical cost of psychotherapy ranges from $100 to $200⁹ a session, dependent upon the state and the length of the session.

In addition, cognitive behavioral therapy (CBT) sessions can cost between $100 and $200 per session, while dialectical behavioral therapy (DBT) usually consists of a weekly individual therapy session, a weekly group therapy session, and weekly phone conversations. DBT costs vary depending on the type of services rendered.

Telehealth therapy for ADHD patients, especially those in rural communities with limited access to treatment facilities, is also beneficial. More than 66 million people in the United States reside in non-metropolitan counties with a mental health professional shortage, according to the Rural Health Information Hub.¹⁰ Telehealth sessions for the treatment of ADHD can range from anywhere from a fixed monthly cost to $275 a session.