Brad DeLaruelle <LNUSCSI.bdelar01 at eds.com> wrote:
>I have an 8 year old son who has been diagnosed with ADHD by a very
>reputable pediatric neurologist. He has been on a mild dose of ritalin
>for a year and a half. His behavior at school and his ability to learn
>and concentrate have really improved, as well as his grades. I have
>2 problems now. (1) He realizes that he has to have this medicine and
>so do other kids. They are making fun of him a lot, and about the
>tutoring he receives, driving his self-esteem into the ground. He has
>a very hard time making and keeping friends. (2) My health insurance
>will no longer pay for Doctor's appointments. While, as my Doctor as
>written to the insurance carrier director, ADHD is a medical condition,
>the diagnosis code for the office call falls into the 31000 series. This
>makes the diagnosis a phsychological one in the insurers eyes. His
>office calls are then treated as "group sessions", and has a limit of
>5 sesions. Subsequently, after his 5th office call, none of the visits
>to the doctor are covered (my son goes quarterly). I have called my
>insurance carrier, who is unyeilding on the acceptance of the 31000
>series as pshycological. The doctor's office says their hands are tied.
>I could use some help and advice. Thanks.
You have to be kidding me. Find a doctor who cares more for his
patients than his diag codes and he/she will give you another code so
the visits are paid for.
Dahn J Finard
