Attention Deficit Hyperactivity Disorder, more commonly referred to as ADHD is classified as a chronic neurological condition that can manifest in many observable ways including an innate affinity or propensity for impulsivity and inability to pay attention. The patient diagnosed with ADHD has obstructive difficulty with even minimal focus of concentration, and engaging in passive activities, or both simultaneously. Although ADHD is present at birth, diagnosis before the ages of 4 and 5 is difficult unless a child exhibits severe or prominent symptoms. Some patients, however are not diagnosed until they reach adulthood. The disorder occurs in an estimated 8% of adolescent school children within The United States and according to The National Institute of Health this figure is expected to grow exponentially.
There is a lot of controversy regarding ADHD when it comes to major medical health insurance. Some plans cover the condition while others do not and yet some will consider providing coverage under very specific guidelines or stipulations.
This article was created to assist interested applicants with proper preparation to obtain a health insurance plan that will cover the treatment of ADHD without endorsing limitable riders or attached exclusions written on the policy when placed and issued.
In the individual private healthcare market ADHD specialty coverage is categorized under mental health treatment benefits so generally speaking as a guideline any plan excluding mental health related benefits will not provide coverage for ADHD. Most plans specifically exclude ADHD coverage altogether in their schedule of benefits so be especially prudent when considering a plan and ask your broker to quote you only on plans that do.
Now that we have the worst behind us there is some good news. First, most states have enacted mental heath parity laws to cover ADHD if a proposed applicant is approved, so if the health insurance company approves an application after an initial medical underwriting review screen then they have to provide coverage for ADHD. The federally mandated states which are applicable for the individual private healthcare market constitute of Alabama, California, Connecticut, Delaware, District of Columbia, Georgia, Indiana, Kansas, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nevada, New Jersey, Ohio, Oklahoma, Rhode Island, South Dakota, Vermont, Washington, and West Virginia.
Secondly, if the applicant is domiciled in a resident state not enlisted above and a plan covering treatment of ADHD has been applied for, it is imperative to prepare for the ensuing interrogative underwriting questionnaire screening. There are basically three underwriting concerns with ADHD and preparation with underwriters is vitally paramount or key to obtain a successful outcome.
(1) The first concern is that there is a high incidence of depression with ADHD. Depression carries its own underwriting risk. In addition, stimulants have been known to increase the severity of depression, which could pose a cumulative risk for co-morbid conditions.
Tip: Insurance companies are very skeptical about approving an application on behalf of an applicant with a diagnosis of certain anxiety disorders or depression. The confusion relies on the fact that medications currently being used to treat ADHD are all considered “off label” treatment, meaning its clinical utilization has not been approved by the United States Food and Drug Administration. These prescriptions include stimulant preparation such as Ritalin, Concerta, Metadate, or Adderal as well as non-stimulant medications including Wellbutrin, Effexor, and Strattera which are commonly used to treat depression. If any of these drugs are being used, clarification to the health insurance underwriter along with notes from the physician about their role in treating ADHD and not depression will aid tremendously. At present, the only medication that looks like it will have official approval by the FDA for the treatment of ADHD is Strattera.
(2) The second concern is that there is a motor vehicle driving risk with ADHD. This includes a higher risk for fatal accidents, casualties, and more citations for speeding or reckless driving.
Tip: Statistically ADHD is associated with an increased risk for hazardous accidents, collisions, and fatalities. Stimulant treatment along with immediate release Methylphendiate has demonstrated to improve driving performance and neuropsychological functioning. A clean driver record along with a written prescription from a licensed practitioner of medicine has worked well for medical clearance in underwriting decision making.
(3) The third concern is that there is a higher incidence of substance abuse present with ADHD. This includes an early onset of chemical addiction, a longer frequent period of induced intoxication, and a lower rate of recovery.
Tip: There is statistical epidemiologic data indicating that ADHD and substance abuse coexist or occur together more frequently than chance alone. In some aspects studies have found the root of this problem may be linked to overtly being overmedicated to stimulants therefore cultivating neurotransmitters to the drugs addictive properties. This one is tough to beat, health insurance underwriters reserve the right to request a paramedical examination if there is reason to have suspicion. In this case consider detoxification protocols several days before an application is submitted. There are numerous methods of accomplishing this and proving the information here may be beyond the scope of this article but at least now there is sufficient time for preparation.
If you or someone you now is diagnosed with ADHD and is experiencing a difficult time obtaining health insurance at reasonable prices or conditions because of this, please visit our website at and leave your contact information so one of our licensed agents can help you.