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Does Cigna Cover ADHD Testing & Treatment?

Does Cigna Cover ADHD Testing & Treatment?

Does Cigna Cover ADHD Testing & Treatment?

Yes, Cigna insurance may be able to cover attention deficit hyperactivity disorder (ADHD) testing and treatment in Tennessee. Coverage for behavioral services may differ depending on your plan’s details and coverage level.1

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How to Verify Cigna ADHD Coverage

Athena Care is in-network with most major insurance plans. Filling out our free, no-obligation online insurance verification form is the easiest and quickest method to determine if your Cigna ADHD coverage includes ADHD evaluations and treatment in Tennessee.

Let our highly experienced, expert care coordinators handle the difficulties of contacting your insurance carrier for more information about Cigna ADHD testing and treatment. A care coordinator will review your policy and thoroughly explain your options after you’ve completed the form. Rest assured, all submitted or discussed information is kept confidential.

What is ADHD?

Attention Deficit Hyperactivity Disorder, or ADHD, is a widespread neurobehavioral condition marked by persistent issues with executive functioning skills, including brain activities that control attention, memory, organization, motivation, impulsivity, hyperactivity, time management, social skills, and other functions. These problems begin in childhood and can last a person’s entire life, resulting in unstable relationships, subpar school or work performance, low self-esteem, and other concerns.

Signs & Symptoms of ADHD

Children with ADHD may do these things significantly more often than other children: 

  • Daydream, seem lost in thought 
  • Forget or lose things 
  • Squirm or fidget, have trouble sitting at the dinner table or school 
  • Talk too much 
  • Make careless mistakes 
  • Take unnecessary risks, act before thinking 
  • Have a hard time resisting temptation 
  • Have trouble taking turns, blurt out answers, or frequently interrupt others 
  • Have difficulty getting along with others
  • Take longer to perform tasks or hurry through them
  • Have low self-esteem 

For adults, ADHD symptoms typically begin in childhood and don’t disappear. However, if symptoms start after childhood, other diagnoses may be considered. In addition, adults with ADHD often don’t know they have it – they just know that everyday tasks seem more challenging for them than for most people. Symptoms of ADHD in adults may include:

  • Feeling like life is an endless race to keep up with work, family, and social responsibilities, as unfinished projects, chores, and paperwork pile up around them.  
  • Overlooking essential details, getting derailed by distractions, losing track of time, and missing deadlines.  
  • Experiencing quick, intense emotions and becoming highly agitated when waiting in line or driving in traffic. 
  • Feelings of performing consistently below their potential and assuming that their issues result from laziness, lack of willpower, or poor self-control. 

Does Cigna Cover ADHD Testing?

Cigna ADHD testing may be covered depending on your specific insurance plan’s benefits. When the requirements of the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM- 5)2 are met, services for the treatment of ADHD are considered medically required. All practitioners use the DSM-5 criteria as a standard of care.

Unfortunately, no specific tests can diagnose ADHD. An ADHD diagnosis is clinical, based on the results of the history, physical examination, and patient/family interviews. The following are some of the well-known diagnostic techniques for assessing ADHD:

  • An interview with the parent and the child (to rule out other psychiatric or environmental causes of symptoms)
  • A medical examination includes a thorough medical history and a physical exam (to check for coexisting conditions). Oppositional defiant disorder, conduct disorder, depression, anxiety disorder, and learning difficulties are common coexisting psychiatric and developmental disorders in children diagnosed with ADHD.
  • An electroencephalogram (EEG) or a neurological consult if focused signs or clinical findings point to a seizure disorder or a degenerative neurological condition.

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 psychotherapy may be used to treat ADHD.

Relationships, quality of life, productivity, and mental health are all harmed when ADHD is left untreated. In addition, ADHD is connected to a slew of undesirable consequences, including:

  • Underachievement in school and at work
  • Self-esteem issues
  • Substance use disorders
  • Employment issues
  • Increased rates of divorce
  • Increased rates of depression and anxiety

Does Cigna cover ADHD Treatments & Medications?

Yes. Cigna may cover specific ADHD treatments and medication management. ADHD stimulants are considered medically necessary when certain criteria, like a diagnosis, are met. The criteria vary with the prescribed medication.3

Psychostimulant drugs, such as methylphenidate and other amphetamines, are the most well-studied and widely prescribed medications for ADHD. In addition, the American Academy of Pediatrics (AAP) recommends that children with ADHD be treated with both 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.

Cigna ADHD medication coverage may include:

  • Stimulants4
    • 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-Stimulants5
    • 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. However, because the peer-reviewed medical literature does not support the use of these health services for ADHD, Cigna considers them experimental and exploratory for the testing and treatment of ADHD. Therefore, Cigna does not cover these types of medicines.

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

With Athena Care, gaining access to ADHD testing clinics in Tennessee has never been easier. Allow one of our care coordinators to assist you with any questions or concerns about Cigna ADHD treatment coverage 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 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

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

How Much Does ADHD Testing & Treatment Cost Without Insurance?

The following are average costs for therapy, though they may differ 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 $187.97.6

In the United States, the typical cost of psychotherapy ranges from $100 to $2007 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 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 is also beneficial. Telehealth sessions for the treatment of ADHD can range from anywhere from $150 – $200, depending upon the state’s treatment options and whether or not your Cigna insurance is accepted.8

Sources

  1. “Attention-Deficit/Hyperactivity Disorder (ADHD):
    Assessment and Treatment.” Cigna Intellectual Property, Inc., 2022, https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0231_coveragepositioncriteria_adhd_assessment_and_treatment.pdf
  2. “DSM-5® Diagnostic Criteria.” Takeda Pharmaceutical Company Limited, 2019, https://www.qandadhd.com/diagnostic-criteria
  3. “Attention Deficit Hyperactivity Disorder (ADHD) Stimulants.” Cigna Intellectual Property, Inc., 2022, https://static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/p_0047_coveragepositioncriteria_ADHD.pdf
  4. “Medicines for ADHD (Attention Deficit Hyperactivity Disorder).” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=pl1029#pl1030
  5. “Attention Deficit Hyperactivity Disorder (ADHD).” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=hw166083#hw166085
  6. “The Costs of Childhood ADHD.” WebMD LLC, 2022, https://www.webmd.com/add-adhd/costs-childhood-adhd
  7. Lauretta, Ashley. “How Much Does Therapy Cost?” edited by Alena Hall, Forbes Health, 2021, https://www.forbes.com/health/mind/how-much-does-therapy-cost/
  8. Rendall, Jessica. “Getting an ADHD diagnosis has gotten easier online. Is that a good thing?” CNet, 2022, https://www.cnet.com/health/medical/getting-an-adhd-diagnosis-has-gotten-easier-online-is-that-a-good-thing/

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155