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.
• ADHD Treatment
• 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

90 - 120 minutes with the patient

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 issue's complexity, 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 insurance coverage with BUPA may or may not include pre-existing conditions such as Autism and ADHD. For most policies, this is an exclusion. However, suppose you approach your PMI provider requesting authorisation for ADHD/Autism assessment. In that case, they do not yet have a diagnosis and therefore do not know whether symptoms are because of a pre-existing condition such as ADHD/Autism and are an exclusion or for a different mental health condition covered by your policy. They also are unable to authorise a specialist assessment for Autism/ADHD directly because of the above. If you do have cover for pre-existing conditions, they still can not authorise a specialist assessment in most cases as there is no preliminary assessment which recommends it and concludes that no other mental health condition seems to be causing these symptoms, and a specialist assessment is indicated. It could also be the case that the symptoms are not because of ADHD/Autism, which would make you eligible for treatment even if your policy excludes neurodevelopmental conditions.

BUPA’s advice to professionals is that in all cases concerning ADHD/Autism assessment, they would only authorise a standard psychiatric assessment as a starting point. If the standards assessment concludes that you need a specialist assessment, then you can make a further authorisation request to BUPA for a specialist assessment, which would then be reviewed by BUPA for consideration of authorisation. Please note that this is a process that I can not influence. I’ll forward you my report following the initial assessment so you can forward it to BUPA for consideration. Please note that I cannot forward the report to BUPA or make a pre-authorisation request on your behalf.

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

You can alternatively self-pay and claim back the cost if this is possible under your policy. Please note that the diagnostic assessment does not include treatment, which is a separate consideration, and in almost all instances, ADHD treatment is unlikely to be funded by BUPA. Please refer to my page https://umid.co.uk/drbaig for details of what assessment and treatment for ADHD may look like.

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 90-120 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 you and your family
• Either completion of questionnaires or a 30-60 minute phone or video appointment with a close relative. A member of my clinical team will complete this.
• Two-hour appointment with you, including assessment and discussion of management options

ADHD Treatment

Please note ADHD assessment and treatment are separate processes. ADHD Treatment requires four additional follow-up appointments with me at baseline, 4, 8 and 12 weeks for medication titration and monitoring. These are mandatory appointments for close monitoring of medication, adjusting doses, and managing side effects, and treatment can not be initiated until these have been booked. I must ask you to arrange physical observations (pulse, blood pressure, weight, ECG only in some circumstances) with your GP before these titration appointments, as these checks are mandatory. I cannot make these arrangements in private psychiatric practice.

ADHD medications are a specialist area - GPs cannot initiate, monitor or adjust dosages, and I can not request any NHS service to provide aftercare following the assessment. Prescriptions from me are private and have associated costs at pharmacies. Many GPs will take over prescribing once your dosage is stable under shared care, but they do have the right to decline. If shared care after three months is a consideration, please do check with your GP that they would be happy to do so before requesting an assessment.

Please note I only conduct ADHD and autism assessments for adults over 18.

I hope this information helps explain the process. Please let me know if you have any other questions by emailing my practice management team at umid@umid.co.uk

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. A face-to-face appointment can only be arranged at Priory Well Being Centre Southampton on a Tuesday.
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 carebit 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.