Health Insurance and Attention Deficit Hyperactivity Disorder (ADHD)

ADHD specialty coverage is categorized under mental health treatment benefits in the individual private healthcare market. Any plan that excludes mental health related benefits will not be provided with insurance for ADHD. One should be prudent when considering a plan as most plans specifically exclude ADHD coverage in their schedule.

There is some good news, most states have made some mental health parity laws to cover ADHD if a patient is approved. If the health insurance company approves an application after an initial medical underwriting review screen then they have to provide coverage for ADHD patient. 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, it is imperative to prepare for the ensuing interrogative underwriting questionnaire screening, if the applicant is domiciled in a resident state not enlisted above and a plan covering treatment of ADHD has been applied for. The key to obtain a successful outcome is the three underwriting concerns with ADHD and preparation with underwriters which is vitally high.

   1. ADHD can cause depression in people. Depression carries its own underwriting risks. It has been known for stimulants to increase the severity of depression, which can also have a 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. It has been shown that the medications of ADHD are all considered as “Off label”. It means that the medications have not been proved 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. The only medicine for ADHD that has been proved by FDA 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: ADHD is associated with an increased risk for 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) There is also a higher incidence of substance abuse present with ADHD. There is an early onset of chemical addiction, a longer frequent period of induced intoxication, and a lower rate of recovery.