Navigating Insurance for Reactive Attachment Disorder: What Families Need to Know

Parenting a child with reactive attachment disorder means navigating crisis, insurance hurdles, and countless unknowns — often all at once. But you can learn from someone who’s walked this path, so you don’t have to go through it alone.

As a parent of a child with reactive attachment disorder (RAD), also called developmental trauma disorder (DTD), it took years to piece together how the disorder showed up in our family — and what strategies, tools and treatments could help. Unfortunately, one of the hardest pieces of this puzzle was another puzzle entirely: learning how to navigate insurance to access and fund necessary treatment (read "Why Parents Can't Heal Childhood Trauma With Love Alone"). What I discovered, bit by bit, was that figuring out RAD insurance coverage can be just as confusing and frustrating as the disorder itself.

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I didn’t become a member of RAD Advocates until it was too late for our family to fully change course. Looking back, I believe we would have found the right path much sooner — and saved ourselves years of time, money, and heartbreak — if we’d known to lean on their expertise from the start.

Here’s what I wish we had known sooner about navigating insurance for a child with reactive attachment disorder:

1. Insurance rarely covers the treatments that actually help moderate to severe RAD.

There are very few truly effective treatments for reactive attachment disorder, especially for children on the moderate to severe end of the spectrum (read "Reactive Attachment Disorder Treatment: The Paths That Do and Don't Work for (and from) Families"). RAD is a serious brain disorder caused by early abuse or neglect that fundamentally alters how a child’s brain develops. It destroys trust in caregivers and fuels a relentless drive to stay in control. Most traditional approaches, like talk therapy or play therapy, actually give the child new ways to manipulate adults — deepening the disorder instead of easing it.

What I discovered, bit by bit, was that figuring out insurance coverage for reactive attachment disorder can be just as confusing and frustrating as the disorder itself.

Outpatient treatment with a skilled, RAD-specific provider can sometimes help children on the milder end of the spectrum. But for many children with moderate to severe RAD, outpatient treatment doesn’t begin to work until after more intensive, often in-patient, RAD-specific interventions have laid the groundwork for trust and safety. Unfortunately, insurance rarely fully covers either level of care. As Amy VanTine of RAD Advocates says, “RAD-specific treatment requires a lot of attention. That costs a lot of money.”

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In our family’s case, insurance continued to pay only for the most widely accepted approaches, which simply didn’t work for our situation. We cycled through providers who either weren’t equipped to handle reactive attachment disorder or eventually discharged our son for refusing to participate or making no progress. It was a discouraging, exhausting process that took up needless time and money.

2. Coverage often comes with strict limits on mental health visits.

Even if you do find a RAD-specific therapist who can meet your child’s needs — typically after more intensive work has laid the groundwork — many insurance plans still cap the number of sessions per year. My own insurance, which is considered generous, pays for 26 mental health visits annually. If we followed our therapist’s recommendation of three sessions per week, we’d run out in just two months. For families dealing with complex developmental trauma, these limitations often mean paying out of pocket or facing long gaps in care that undercut any progress made.

3. Medication may be covered — but it won’t treat the root of RAD, and getting the right approach is hard.

There is no medication that directly treats reactive attachment disorder. Because RAD is a disorder of trust and relationship, true healing still depends on intensive relational work — something insurance rarely wants to pay for.

That said, the right diagnosis and medication can sometimes make a critical difference by helping regulate mood and lessen extreme behaviors, so children are more able to participate in the treatment RAD actually requires. Many kids with RAD also have co-existing conditions, often bipolar disorder, which if misdiagnosed or mistreated can make everything worse. Too often, kids end up on antidepressants or stimulants that actually intensify mood swings and aggression.

Dr. John Alston — a retired psychiatrist RAD Advocates has vetted as a trusted clinician for families navigating this disorder — has treated thousands of children like ours. He’s spoken at a past Navigating RAD event, sharing how looking at family history, genetics, and mood instability often leads to more accurate diagnoses and better-targeted treatment. His approach involves carefully considering mood stabilizers and atypical antipsychotics when appropriate, which can help kids become more receptive to the deeper therapeutic work RAD requires.

In our family’s case, insurance continued to pay only for the most widely accepted approaches, which simply didn’t work for our situation. We cycled through providers who weren’t equipped to handle reactive attachment disorder. It was a discouraging, exhausting process that took up needless time and money.

Even then, finding a psychiatrist who understands this — and navigating insurance to cover the right medications — is another major hurdle. We wish we had known sooner how much the wrong medications can delay healing, and that it might take advocating for a trial of mood stabilizers to see meaningful change.

You can read more about Dr. Alston’s work and why these medication considerations matter in our full article here.

4. Short-term crisis care is usually covered, but it’s only a temporary solution.

While insurance companies typically won’t pay for the intensive, long-term treatments children with reactive attachment disorder truly need, they do cover short-term hospitalizations. RAD Advocates often coaches members to use these stays first and foremost to keep everyone safe, while also beginning the process of building documentation that could be critical down the line.

These acute in-patient stays are generally intended to stabilize medication or address immediate safety concerns. They usually last anywhere from three to fourteen days — far too short to create meaningful change for a child with deep developmental trauma.

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In our family, these hospitalizations sometimes felt like the only option left when our son’s behaviors became too dangerous to manage at home. The longest admission he had was 17 days. By day 16, the insurance company cut off coverage, even though he was still unstable and making violent threats. The facility warned us we’d be billed $1,000 a day if we insisted on keeping him there without insurance paying.

It’s also important to know that insurance companies often only cover specific facilities or networks. During our son’s first acute in-patient stay, his therapist told us to take him straight to the pediatric ER to get admitted because he was in deep crisis and unsafe at home. By the time he stopped raging, it was well past midnight, and the admission process stretched until six in the morning. I was a scared, sleep-deprived mom whose son was in crisis — not in any state to make careful decisions about what insurance would or wouldn’t cover. I had no idea that the ER, the ambulance that transported him, the facility itself, and all the providers there were out-of-network. We ended up with a $40,000 bill for a five-day stay.

The following year, we switched to an insurance plan with better mental health coverage and a low deductible. After that, no acute stay ever cost us more than $1,500. It was a hard and costly lesson in how much these choices — often made in moments of desperation — can matter.

For other families navigating this, it’s important to understand that these hospital stays are mainly about short-term crisis stabilization, not true healing (read "The Most Important Things to Know and. Do if Your Child With RAD is in Residential Treatment"). Recognizing that upfront can help set more realistic expectations, plan for the costs, and ensure that each stay still contributes to showing how serious and persistent the child’s needs are. If you can, try to plan ahead by knowing which hospitals or facilities are in-network with your insurance and mapping out the route before you’re in the stress and urgency of a crisis. That way, if you ever do face an emergency, you’re more prepared to protect both your child’s safety and your family’s finances.

5. You’ll need extensive documentation of failed lower-level care.

Over the years, our family scrambled from therapist to therapist, trying to find help for our son. Many eventually discharged him for refusing to participate or showing no progress, each writing a letter in hopes it would support our case for more intensive care. Insurance companies — whether private or through Medicaid — often demand proof that less intensive interventions have failed before they’ll even consider paying for long-term residential placement.

In our situation, we were told that our son needed at least two acute hospital stays within six months before we could pursue higher levels of care. That meant taking him in every time he became violent or unsafe, even though not all visits resulted in an admission.

It’s important to understand that hospital stays are mainly about short-term crisis stabilization, not true healing. Recognizing that upfront can help set more realistic expectations, plan for the costs, and ensure that each stay still contributes to showing how serious and persistent the child’s needs are.

For many families, Medicaid can be both a lifeline and a labyrinth. It’s a common source of funding for children who’ve been adopted or are in the foster care system — although not all kids with RAD come from those backgrounds. When we finally got Medicaid reinstated after a lapse, it still took nearly two years of repeating treatments that had already failed just to meet documentation requirements. And then, before covering an out-of-state RAD-specific facility, Medicaid insisted our son try and fail at all in-state programs that didn’t specialize in reactive attachment disorder. “This practice often makes the disorder worse as inappropriate therapies are attempted and uneducated professionals are manipulated and triangulated by the disorder,” says VanTine. “All this does is delay proper treatment and reduce the likelihood of positive outcomes when or if proper treatment is finally implemented.”

A crisis therapist once asked me point-blank what I wanted from another assessment. I answered simply, “Documentation.” She immediately understood and helped us secure another acute stay. These records ultimately became critical evidence showing just how serious and persistent our son’s needs were — exactly what insurance reviewers look for before approving more substantial care.

Finding a Path Forward

If you’re just beginning this journey, know you’re not alone — even if it often feels that way. So many parents before you have struggled through the same insurance battles, repeated treatments, and agonizing waits for proper care. We didn’t have the benefit of learning from others who had already walked this road, and I genuinely believe it would have saved us time, money, and some of the heartache that comes from feeling lost in a system that doesn’t understand this disorder.

Wherever you are in this process, it can make all the difference to connect with parents and professionals who know how these systems work, what documentation matters most, and how to advocate for the right level of care. While every insurance plan is different — and it’s always important to review your specific policy and speak directly with your provider — these are the patterns we’ve most often seen among families navigating reactive attachment disorder.

As we’ve learned, there are meaningful steps you can take. Keep thorough records of every therapy attempted and each professional report, even when it feels futile. Know that short-term hospital stays, while not a long-term solution, can create immediate safety and contribute essential documentation — and that planning ahead by knowing which facilities are in-network can save enormous financial stress when a crisis does happen. Seek out trusted clinicians who consider mood disorders and family history when exploring medication.

And above all, remember there are others who truly understand what you’re facing and want to help lighten the burden you’re carrying. Many families have walked this road before you — and there is real hope in learning from those who’ve faced similar struggles.

Not sure where to turn for your family living with a child impacted by childhood trauma?

 You’re not alone — it's different for every family and you don’t have to figure it out on your own. Connect with RAD Advocates to find real answers from those who’ve walked this path.