ADHD evaluation with Kaiser

Please don’t let Kaiser off the hook in any event. File a grievance with the Plan and if that doesn’t expedite an appointment, file a grievance with the Dept of Managed Health Care. Kaiser is obligated by law to provide behavioral health appts in a timely manner and they continue to shirk despite having been assessed multimillion dollar penalties. They pay the penalty yet patients continue to get the runaround. See their settlement agreement with the DMHC: https://www.dmhc.ca.gov/AbouttheDMHC/Newsroom/July18,2017.aspx

It states: If a consumer is experiencing difficulty accessing care they should file a grievance with their health plan. If they are not satisfied with their health plan’s resolution of the grievance or have been in their plan’s grievance system for 30 days, they should contact the DMHC Help Center for assistance by calling 1-888-466-2219 or at www.HealthHelp.ca.gov. If they are experiencing an imminent or serious threat to their health, they should contact the DMHC Help Center immediately.

—Also, if Kaiser fails to provide your son timely, necessary care, you may be able to get Kaiser to pay or reimburse for out-of-network care. 

Since you mention IEP/504, it sounds like you are in a public school system.  If so, you should request an evaluation through your school.  The sooner the better so that it can be completed before the end of this school year.  Check out dredf.org for more information.

Hi. I'm a retired school psychologist, and I wanted to make sure you know that you can request a 504/IEP evaluation before you have a medical diagnosis. It can help but a Dx is not required to qualify for those accommodations/services if the school evaluation shows an educational impact. Since the school assessment also takes time, you might want to make that request and let them know you are also pursuing an outside diagnosis concurrently. They will have 15 days to reply to your request, and after you sign permission for the evaluation, it must be completed within 60 days (not including summer vacation). It may get you farther along the process a little quicker. Good luck!

Our kid was diagnosed through Kaiser’s group process, and they did a very thorough evaluation.  Kaiser offers group informational sessions for parents about ADHD and medication options.  Both sessions were worthwhile.  ADHD medication is very expensive without a healthcare plan, so unless you have an alternate health plan it is worth going through the Kaiser process.

You don’t have to wait to get a diagnosis to get started on the school support system (504 or IEP).  DREDF offers free informational courses and has sample letters to write to your school to begin the evaluation process.  The school has a separate formal process to evaluate whether your kid qualifies for a 504 plan or IEP. 

We are in OUSD, and we had to go through an appeals process just to get a 504 plan.  The process was very slow, but we did finally get some support for our kid.  

Good luck!

If your child is struggling academically you should go ahead and make a written request to his school to be evaluated for a learning disability. The school has to then respond with a plan for testing within 10 days. ADHD can qualify a child for an IEP as “other health impairment”. Having the assessment from Kaiser will help, but I’d do both routes at the same time.

Hi, I am sorry you are going through these challenges.

I'm going to quickly type through some details you may not have been given. Education law is complicated and best learned through a resource such as DREDF or find an education attorney. My kids have been through special ed so my background is as a lay person and not as a professional.

It seems that your goals is to become eligible for accommodations (504) or services and accommodations (IEP) in the student's educational setting. It's crucial to understand the difference between a medical diagnosis vs school district assessment testing for determine eligibility (or not) for accommodations and services so that your student can access their education via FAPE. A medical diagnosis will not result in or justify a 504 or IEP, but may open some doors to services outside of school.

If you haven't yet initiated the formal legal process for school district assessment testing in all areas of suspected need, get that clock ticking and have all your actions firmly documented ASAP. Be sure to describe specific symptoms, specific behaviors, and how it prevents the student from accessing their education, and do not refer to a diagnosis unless you have one from a liscensed clinician as not all diagnosed symptoms and behaviors prevent a student from accessing their education, keeping in mind that "education" is an all-encompassing term that includes BOTH academics and social/emotional development. Some district will try to prevent you from requesting an assessment and there are a lot of canned excuses you may be given, such as that the problem is the home environment, the student is at grade level at school, the student is smart, they see no problems, you don't want your child labeled, some holiday period is starting, you should change to a private school, you should wait until a certain date or grade, etc etc etc.

If the District does not find eligibility, then you request an independent evaluation called an IEE. 

You certainly can seek a medical diagnosis and get the ball rolling for assessment testing to determine eligibility at the same time. Just be aware that the limiting factor for school services is getting the school assessments completed, not the medical diagnosis.

That's beginners ed law in a nutshell. Do take advantage of resources such as DREDF to get educated about the process.

Best wishes.

The school will do their own evaluation whether you have a diagnosis or not, unfortunately. It's very duplicative - but schools have to determine whether the disability impacts the child's access to education. So asap write to the school (and get it date-stamped if you can) to request an IEP. That starts a timeline - they have 15 days to get you an assessment plan, and then once you sign it, they have 60 days to complete the assessments and hold an IEP meeting. At that meeting they tell you if your child qualifies for an IEP. It's definitely helpful to have an outside assessment, but not required before you can ask for the IEP - do both at the same time. I highly recommend you take an IEP training class for free from an organization like DREDF, so that you're aware of all of your rights. If you're on Facebook, look for groups for Castro Valley special education and also there's a Bay Area IEP Facebook group. Good luck - having the medical diagnosis will help if your child isn't found eligible and you need to appeal, and if you want services through insurance.

I'd recommend working with your Kaiser pediatrician to do an initial screening and see if a more escalated evaluation is needed and can be scheduled, or going in for the appointment in March.  Reason being is that you want to stay with the integrated health care system, and any recommendations or referrals can be coordinated by them or via Child Psychiatry.  In the interim there are things that can be done via your pediatrician, and you can also self-refer to Child Psychiatry at Kaiser.  Also, if you are referred to a specific specialist (Child Psychiatrist or Developmental Pediatrician) you'll be see in 10 business days or less. You might also see if another local Kaiser facility can see your child sooner (KP Oakland, SF, San Leandro, Fremont, Walnut Creek etc etc)

Aside from incurring costs by going out of network/pocket, there can be variations in diagnostic determinations (where kids are over/under diagnosed) and in the fee-for-service world there can be providers that will then try to establish services (beyond an evaluation)  that could be complicating and also increase your out of pocket expenses.  If your 10yo's symptoms are more severe, then again follow-up with your pediatrician and they may deem evaluation/treatment sooner, otherwise it is probably not likely to be harmful to wait a little more.  

My $0.02.  Best of luck to you and your family.

I think you got some great information and resources in the previous responses. I just wanted to add that we're currently in the assessment process through Kaiser Union City. I already attended the initial group consultation (scheduled within 2-3 weeks of inquiry), so I wonder if that specific Kaiser has more capacity. If you can travel, perhaps consider them. Also, it helps if you request the assessment forms be mailed to you in advance of the group consultation - the forms are lengthy and they ask for two parents/caregivers to separately complete forms, and there's also a teacher form to be completed. Having them in advance can help speed up the process.