Patient Rights

The Mental Health Parity and Addiction Equity Act

If you suffer from ADHD, the 2008 Mental Health Parity and Addiction Equity Act helps ensure that you aren’t charged more by your insurance company because you are seeking mental health treatment. The act makes it illegal for insurance companies to charge higher co-pays to patients seeing a mental health professional than they do to those dealing with physical conditions. Insurers also can’t put a limit on the number of office visits a patient can have with a therapist.

“At the moment, the terms of the act only hold true if you get insurance through an employer with more than 50 employees,” says Clare Miller, director of Partnership for Workplace Mental Health at the American Psychiatric Foundation. “If that doesn’t describe your situation, check to see if there’s a state law that offers more protection.” If you suspect that your insurance company isn’t following the law, the Mental Health Parity Watch website at mentalhealthparitywatch.org has a toolkit to help you find out.

Talk with Your Insurer

Not every insurance company offers mental health benefits, nor are they legally required to, so call your insurer before making appointments with a psychologist or psychiatrist. While you’re on the phone with your health insurer, ask how many therapy sessions they cover and request a list of which psychiatric medications are covered in different pay tiers. That way, if your doctor prescribes an ADHD medication, you’ll have all the information you need to ensure that you aren’t saddled with a large co-pay.

Saving Money on ADHD Treatment

Whether it’s you or your child who has ADHD, the treatment plan is the same: a combination of medication and behavioral therapy. Both can be expensive, but there are ways to cut your costs. The most well known drug for treating ADHD is Adderall, but there are other options, such as Ritalin and other psychostimulants. Adult patients may also be prescribed an antidepressant.

Find out from your insurance company which ADHD drugs are in the lowest copay tier and have that information ready when you meet with your doctor. Since you will likely be taking these drugs for a long period, send your prescription to a mail-order pharmacy. You’ll get a 90-day supply of the drug and pay a smaller fee. If you don’t have a prescription plan or are uninsured, look into the Partnership for Prescription Assistance at pparx.org. It’s a program that will help you get discounted medication if you meet certain income qualifications.

When it comes to behavioral therapy, you’ll need to see a psychologist. If you don’t have insurance, try to find a therapist who offers a sliding scale (a way of charging people less if they are paying in cash as opposed to using insurance). You can either ask your primary care physician for a recommendation or call up the psychologist’s office and ask. Don’t be embarrassed—you won’t be the first to ask questions about pricing.