Coverage for ADHD Kid in Georgia

[Bob_The_Insurance_Guy]

Attention all Georgia reps:

Does anyone know of a company that will cover a 14 yr old male, already diagnosed with ADHD. His mother is changing employers and will be losing group coverage May 1, and can't afford COBRA.

He takes Clonodine and Concerta.

 

[somarco]

Clonidine is inexpensive, less than $10 and probably less at Wally World. Concerta is $110 but there are generics in the $15 range.

Aetna, KP & Humana are the only carriers that come to mind that will cover the kids meds with rate ups.

 

[pathfinder]

I have some experience with ADHD.

There is a generic for Ritalin, but not for Concerta. Problem with the generic is it last only 4 hrs, and takes kids on a roller coaster ride.

Concerta is a specialized delivery system for Ritalin, makes it last for 12 hours and kids don’t experience the up and down problems associated with the 10 and 20 MG.

CHADD is the advocacy group. I saw recently that they were offering some type of discount program for Prescriptions, but don’t know anything about it. Have them check out CHADD.ORG.

Companies don’t like the cost of the meds associated with ADHD.

I usually go the H S A route.

Need any other information, pm me.

 

[Bob_The_Insurance_Guy]

Actually, Coventry will rate him up 50% and take him, with a Dr. note that the Clonodine is for ADHD and not HBP.

KP will rate him up 45%, but needs medical records, not a Dr. note to accept.

I didn't try Aetna.

 

[somarco]

I don't even think of Coventry any more. Too many issues with their underwriting department in the past. They approve risks that others reject and reject risks that others consider standard.

KP will usually allow existing medications as long as they seem to be effective.