Does Ambetter Cover ADHD Testing & Treatment?

Jump to Section

Does Ambetter Cover ADHD Testing & Treatment?

Yes, Ambetter insurance may be able to cover Attention Deficit Hyperactivity Disorder (ADHD) testing and treatments in Tennessee, depending on your insurance plan. The assessment and treatment for ADHD must be deemed medically necessary by a qualified health care professional.¹

How to Verify Ambetter ADHD Coverage

What is ADHD?

Attention Deficit Hyperactivity Disorder, or ADHD, is one of the most prevalent pediatric psychiatric conditions defined by an incessant pattern of inattentiveness and/or hyperactivity-impulsivity that obstructs behavior or growth.² It is commonly diagnosed in childhood and can last well into adulthood.

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. Those with ADHD may struggle to pay attention, manage impulsive behaviors, or be extremely active.³

The additional following signs and symptoms of ADHD persist and can often be severe, leading to issues at school, at home, and in 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

Is ADHD Testing Covered by Ambetter?

Essential Health Benefits are covered by every Ambetter insurance plan, including mental health and behavioral health services. This includes Ambetter ADHD testing.⁴

Unfortunately, ADHD does not have a specific test; it’s clinically diagnosed. To diagnose ADHD, ADHD doctors use a variety of exams, tests, and other information. They 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.

An ADHD diagnosis considers the following:

• 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.

There are many different professionals available to diagnose and treat ADHD. Just a few examples include family doctors, pediatricians, psychiatrists, and neurologists.

It’s important to test for ADHD because untreated ADHD can make children more impulsive, which increases the risk of injury.⁵ Young people with untreated ADHD are more likely to attend the emergency room for injuries, according to several studies. Furthermore, ADHD, when left untreated, can lead to other mental health disorders, including eating and substance use disorders, as well as a disruption to everyday routines and behaviors.

​​​​Are ADHD Treatments & Medications Covered by Ambetter?

Yes. Ambetter ADHD medication coverage is part of the essential benefits.⁶ Your benefit plan will determine your eligibility and the specifics of your Ambetter ADHD treatment plan.

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. Psychotherapy with family members or individually are both effective forms of treatment.

Patients should be closely monitored, and medicine should be taken consistently during medication management. This allows the doctor to check if the patient is getting the correct dose and responding well. After a few weeks on the medication, the side effects usually fade. Alternatively, the dosage might be reduced to minimize side effects.

Medications used to treat ADHD include:

• Stimulants
  • 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-Stimulants
  • 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 use complementary or alternative medicines. Because the peer-reviewed medical literature does not support these health services for ADHD, Ambetter considers them experimental. Therefore, Ambetter may not cover these alternative medicines. However, alternative treatments like acupuncture can assist in relieving stress and muscle tension while also improving your overall health and quality of life.

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

With Athena Care’s multiple ADHD testing clinics in Tennessee, getting the Ambetter ADHD evaluation and treatment you need is a phone call away. A care coordinator can assist you with any questions or concerns Monday through Friday, 7:00 a.m. to 6:00 p.m.

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

In addition to the above, below are a few examples of further questions to consider when seeking Ambetter ADHD testing and treatment:⁷

Questions for the Assessment Specialist:

• What evaluations or metrics do you use?
• Do you abide by the American Academy of Pediatrics practice guidelines for identifying and assessing children with ADHD?
• How can information about symptoms be gathered across various contexts?
• Do you talk to the faculty at the school?
• What age groups of kids have you evaluated before?
• Do you have any information on the services offered by public schools to kids and teens with ADHD?
• How long have you been performing ADHD assessments?
• What kind of report do you give if an ADHD diagnosis is confirmed?

Questions for the Treatment Specialist:

• How do you use medicine in your practice?
• How frequently will you need to see my child for routine office visits?
• What potential side effects might a prescription drug have?
• What other forms of treatment outside medication could you suggest?
• Is therapy included in the course of treatment?
• What typical outcomes have you experienced with your clients?
• What can I do to support my child at home?
• What can the psychologist and teachers of my child do to support my child?

How Much Does ADHD Testing & Treatment Cost Without Insurance?

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

Medication costs can range from $8 to $288 per month, and doctor appointments alone can cost anywhere from a few hundred dollars to over $2,700. For instance, the price of a month’s worth of commonly prescribed generic stimulants is approximately $187.97.⁸

Furthermore, the typical cost of psychotherapy in the United States ranges from $100 to $200⁹ a session, dependent upon the state and the length of the session. For example, Cognitive Behavioral Therapy (CBT) sessions can cost between $100 and $200 per session, while Dialectical Behavior 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 treatment for ADHD patients, especially those in rural communities with limited access to treatment facilities, is also an option and beneficial. According to the Rural Health Information Hub, more than 66 million Americans live in non-metropolitan counties where there is a lack of mental health professionals.¹⁰ Telehealth sessions can range anywhere from a fixed monthly cost to $275 a session.

Some therapists will work on a sliding scale if you do not have Ambetter ADHD coverage or any other type of insurance. The cost of your sessions will probably depend on your income if you find a therapist who provides a sliding scale payment plan. Additionally, this sliding scale will most likely differ from one therapist to another.