If you're thinking about an ADHD assessment for yourself or your child, one of the first questions is usually about money. Is an ADHD assessment covered by insurance, or will you be paying the whole fee yourself? The honest answer is that it depends on your plan, and on who does the assessment. This guide walks you through what to check before you book, without promising anything about what your plan will pay.
We're a counselling and psychology clinic, not an insurance company. We can't see your plan or guarantee coverage. Think of this as a checklist to take to your benefits booklet, your member website or your insurer's phone line.
The short answer: it depends on your plan, and on who does the assessment
There's no single rule across Canada. Each extended health plan is chosen by an employer, a union or a school, and each one decides which practitioners are covered, how much is paid back and what the yearly limits are.
That's why a coworker might get most of an assessment paid back while you get much less. Neither of you did anything wrong. Your plans are simply built differently.
Three things usually decide what happens with an ADHD assessment:
The title of the person doing the assessment
Whether your plan covers that title, and for how much each year
Whether the plan has any rules about referrals or receipts
Why the practitioner title matters
At our clinic, ADHD assessments are done by psychologists. In Ontario, psychologists are a regulated health profession, and the province's page on regulated health professions explains how each title is overseen. Psychologists can diagnose. Registered Psychotherapists and Registered Social Workers provide therapy, and Nurse Practitioners can assess, diagnose and prescribe.
Insurance plans pay by title, so the word on your receipt matters. If your plan lists psychologists, an assessment may fall under that line. If it lists only other titles, it may not.
Plans don't all group titles the same way. One Desjardins plan design, described in its benefits summary for advisors, puts psychologists, psychotherapists and social workers together in one category with a shared maximum. Desjardins also notes on its mental health support page that what's available depends on what each plan covers. Other insurers set things up their own way, so always check your own booklet.
Plan maximums, combined limits and a one-time assessment fee
An ADHD assessment is usually a larger, one-time cost rather than a series of small sessions. That's where plan maximums matter most.
Many plans set a yearly dollar limit for a practitioner or a group of practitioners. If your plan has one shared amount for psychologists, psychotherapists and social workers, then therapy sessions earlier in the year use up the same pot. By the time you book an assessment, there may be less left than you expect.
Some plans also pay a percentage of each claim rather than the full amount. Put together, a yearly limit and a percentage can leave a balance for you to pay. Knowing your numbers ahead of time helps you plan.
A few things worth thinking about:
Timing. If your plan year resets soon, you may want to ask how that affects an assessment.
Shared limits. Check whether the same pot covers counselling and assessments.
Family members. For a child's assessment, ask whose plan to claim first if both parents have benefits.
What about OHIP?
Public health insurance in Canada follows the Canada Health Act. According to Health Canada's overview of the act, insured health services include medically necessary hospital, physician and certain surgical-dental services.
A private psychological assessment at our clinic is not one of those services, so it's usually paid through extended health benefits, a Health Spending Account or out of pocket. We won't go into public routes here, because they vary and change. If cost is a worry, talk with us during a free consultation about what options fit your situation.
Other ways people pay
If your plan doesn't cover an assessment, or only covers part of it, there are a few other paths.
Health Spending Accounts. We accept Health Spending Accounts. These accounts are set up through an employer, and the rules differ from plan to plan, so check what yours allows.
Medical expense tax credit. Some medical costs can be claimed on your tax return. The Canada Revenue Agency's page on eligible medical expenses explains what qualifies, and notes that you can only claim the part of an expense that hasn't been, and won't be, reimbursed. Read the CRA's list or speak with a tax professional before you count on it.
Receipts. Whatever route you use, keep every receipt. Make sure it shows the practitioner's name, title and registration number, since insurers often ask for these.
Direct billing is not the same as coverage
Direct billing means the clinic sends the claim to your insurer for you. It's convenient, but it doesn't change how much your plan pays. You can read about how it works on our direct billing page.
Direct billing is available for some plans, and it depends on the insurer and the clinician's title. For example, we direct bill Desjardins through TELUS eClaims for services with Registered Social Workers, Registered Psychotherapists and psychologists. Services with Registered Psychotherapists (Qualifying), called RP(Q), can't be direct billed to Desjardins, so those are pay and claim.
Questions to ask your insurer before you book
Call your insurer or log in to your member site with your plan details ready. Then ask:
Are psychological assessments covered, and under which practitioner title?
Is there a yearly maximum for psychologists, and is it shared with other titles?
How much of that maximum have I already used this year?
What percentage of each claim is paid back?
Do I need a referral or a prescription for an assessment to be covered?
Is there a separate rule for a child or dependant?
How long do I have to send in a claim after the assessment?
Write down the answers, the date and the name of the person you spoke with. For more background, our guide to Ontario insurance coverage explains how benefits usually work.
Common mix-ups that lead to surprises
Assuming "mental health" means everything. A plan can cover counselling and still have limits on assessments, so ask about both.
Forgetting the referral rule. Some plans only pay if a referral or prescription is on file. Find out before the assessment, not after.
Missing the claim deadline. Most plans give you a set amount of time to send in receipts. Put a reminder in your calendar.
Adults, teens and children: where we assess
ADHD assessments with our psychologists are available in a few places:
Adults in Kitchener-Waterloo, Cambridge and Ottawa. You can read about the process on our ADHD assessment page for Kitchener-Waterloo.
Children and teens, ages 6 and up, in Kitchener-Waterloo and Cambridge.
Ottawa assessments are for teens and adults only.
If you're not sure whether an assessment is the right next step, that's a normal place to be. ADHD can overlap with anxiety, low mood or learning differences, and CAMH explains that a diagnosis depends on how often and how strongly behaviours show up, how long they've lasted and how they affect daily life. That takes more than a quick online checklist. The National Institute of Mental Health also has plain-language information on how ADHD shows up in children and adults.
Your next step
You don't need to have every insurance answer before you reach out. A free 15-minute consultation is a chance to ask about assessment fees, which office suits you, and how billing works for your plan. Assessment fees are discussed during that call. For counselling after an assessment, sessions with our therapists are $130 to $200, and there is a one-time $50 setup fee for new clients, which isn't charged for the free consultation.
Depending on your plan, your insurance may cover part or all of the cost. The only way to know for sure is to check your own plan before you book.