BUPA-funded ADHD or Autism Assessments

by Dr Kaleem Baig

Important Disclaimer

The views below represent the information that patients ask me when making initial contact and the questions they usually ask my admin team to clarify. This is a factual description of my understanding of the approach by BUPA for neurodiversity assessments and is not representative of the views of BUPA, which only BUPA can confirm with you.

• Important Disclaimer
• Terms used
• Introduction
• BUPA’s approach
• Considering the above, my advice for a BUPA-funded consultation with me is as follows.
• Booking Process

Terms used

Standard Psychiatric Assessment/Initial Psychiatric Assessment

This is a formal 40-50 minute psychiatric assessment looking at your difficulties and what might explain them. The evaluation makes recommendations for the treatment plan. Where indicated, the assessment also notes if an in-depth evaluation/further specialist assessments or investigations are needed when the difficulties are more complex, including a specialist assessment for ADHD or Autism. A standard psychiatric assessment can not conclude a diagnosis of ADHD/Autism because of the time and the complexity such specialist assessment requires.

Specialist ADHD/Autism Assessment

These are specialist assessments which have several components. Each assessment requires:

Completion and review of comprehensive psychological measures before the assessment

Gaining information and feedback from a close family member prior to the assessment by completing the neurodevelopmental information form

90 minutes with the patient

Feedback on the diagnostic outcome in the patient appointment

A comprehensive clinical report following NICE guidelines

Introduction

Thank you for contacting me for an adult Autism or ADHD assessment via BUPA funding. I have put together this essential information page for BUPA patients seeking ADHD/Autism assessment. I have written this to cover the questions I get asked at the stage when patients are trying to book an appointment with me and would like to have an ADHD/Autism assessment. Unfortunately, given the complexity of the issue, my admin team can't address these questions with individual patients. I have requested that they direct you to this page for your information.

There are different approaches and limitations in health coverage policies by PMI providers, which are individualised and variable in the context of policy terms and conditions. Many PMI policies exclude pre-existing conditions, and ADHD/Autism is seen as a condition present from childhood.

BUPA’s approach

Your BUPA insurance may or may not cover pre-existing conditions such as Autism or ADHD—these are excluded in many policies. When you ask BUPA for authorisation for an Autism or ADHD assessment, they typically won’t approve it straight away. This is because they don’t yet know whether your symptoms are due to a pre-existing condition (which may be excluded) or another mental health issue that your policy does cover.

Even if your policy includes cover for pre-existing conditions, BUPA usually won’t approve a specialist assessment without an initial psychiatric assessment first. This first step helps determine whether your symptoms are likely due to ADHD/Autism or another condition, and whether a specialist assessment is clinically necessary.

BUPA’s usual process is to authorise only a standard psychiatric assessment initially. If that assessment indicates a need for further investigation into ADHD or Autism, you can then request additional authorisation for a specialist assessment. BUPA will review that request based on the clinical findings.

Please note, I have no influence over BUPA’s authorisation process. I will send you a report following your assessment, which you can forward to BUPA yourself. I’m not able to send the report directly to them or make the authorisation request on your behalf.

Considering the above, my advice for a BUPA-funded consultation with me is as follows.

If BUPA has provided pre-authorisation, please note this is only for a standard psychiatric assessment, not a specialist ADHD or Autism assessment. The standard assessment is a 50-minute general consultation that cannot provide a diagnosis of ADHD or Autism. However, it will offer a clinical opinion on whether another mental health condition may explain your difficulties or whether a specialist assessment for ADHD or Autism is warranted.

I’m happy to offer this standard assessment once you have your BUPA authorisation code. I will invoice BUPA for the standard assessment only and will provide you and your GP with a report including my recommendations. You can then share this report with BUPA and discuss any further authorisation for specialist assessment directly with them.

If you and BUPA wish to proceed with a specialist ADHD or Autism assessment, please ask BUPA to send you written confirmation of the following, which you should then forward to me at umid@umid.co.uk:

1. Confirmation that BUPA has authorised a specialist assessment, specifying whether this is for ADHD, Autism, or both.
2. Agreement that BUPA will cover the full cost of the assessment:
• £1,250 for ADHD
• £1,500 for Autism
• £2,450 for combined Autism and ADHD
3. The pre-authorisation code, procedure code, and impairment code required for invoicing.
4. Your confirmation that you will cover the full cost if BUPA declines payment, or if you cancel or do not attend the appointment with less than 48 hours’ notice.

Alternatively, you may choose to self-fund the assessment and reclaim the cost from BUPA if your policy allows.

Please note that the diagnostic assessment does not include treatment. Ongoing treatment, particularly for ADHD, is considered separately and is rarely funded by BUPA.

The specialist ADHD assessment involves:

• Completing specific pre-assessment questionnaires by you and detailed questionnaires by a close relative who ideally has known you as an adult and as a child.
• A 30-minute phone call with a close relative from my clinical support team if the relative is unable to complete questionnaires
• A 90 minute appointment with you, including a specialist ADHD assessment called DIVA-5. I will discuss the conclusions during this appointment.

I’ll send you and the GP a copy of the report, noting the assessment outcome and diagnostic conclusions.

The specialist autism assessment involves:

• Pre-assessment measures for completion by you
• Collateral information from a closed family member
• 90 appointment with you, including assessment and discussion of management options

Booking Process

Please ensure that you are happy with the information above. If you would like to proceed:

1. Check that you have read the above carefully.
2. Contact us at umid@umid.co.uk (The best way to reach my team for a prompt response) or 01962 435 090 (Monday to Friday, 10 am to 2 pm) to get an idea of availability and book a provisional time for standard assessment, which can only be held for 48 hours. Let us know whether you want a remote or face-to-face appointment.
3. We will then send you a link to the complete booking form and a consent form for us to request GP summary records. Please complete and submit the booking form within 48 hours to confirm the appointment. If we do not receive the form in 48 hours, your slot will get re-allocated, and we will offer a new slot on receipt of the booking form in that case. Completing the booking form is necessary for us to process the personal and clinical data, enter your records on our electronic records system and generate booking links and invoices.
4. We will email you pre-assessment questionnaires for completion before the appointment. These must be received at least 72 hours before the assessment.