Survey: Families Struggle with ADHD Insurance Coverage

 ADHD Weekly 2016-11-17

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CHADD recently concluded a national survey of ADHD community members’ experiences with health insurance coverage for ADHD. The results, drawn from 1,500 respondents, show that insurance coverage for diagnosis and treatment is an ongoing struggle for the majority of people affected by ADHD.

The survey was sent out in September by the CHADD Public Policy Committee to CHADD members and people who have contacted CHADD’s National Resource Center on ADHD. Respondents came from all 50 states and Washington, DC. Of those responding, 95 percent had insurance coverage for themselves or their family members but most reported difficulty accessing insurance benefits.

The results also show that about 60 percent of respondents have difficulties with medication access, and 18 percent reported their insurance plans had denied or refused to cover the cost of medications for them or a family member. Several of the respondents said they had experienced some form of discrimination related to a prescription for ADHD medication.

“The qualifications my insurance requires set up barriers to actual treatment,” one respondent told us in the survey responses.

“What insurance will cover is very limited,” another wrote. Another respondent added, “ADHD treatment has not been covered by our insurance.”

The survey results show that individuals face many challenges to diagnosis and treatment of ADHD even when they have insurance.

The challenges individuals affected by ADHD who have insurance face include:

  • A lack of ADHD professionals who accept insurance
  • A limited number of ADHD specialists within respondents’ travel areas
  • Very few ADHD specialists who are within the insurance network, requiring respondents to pay for the entire cost of treatment or be on long waiting lists for providers
  • Expensive out-of-pocket diagnosis and treatment costs and high co-pays or deductibles
  • Insurance not covering or only covering part of the costs related to diagnosis and treatment
  • For adults, insurance often only covers the cost of medication, but not other services or treatment
  • Difficulty obtaining ADHD medication because of restrictions placed by insurance companies
  • Hurdles set by the insurance companies to obtain reimbursement for diagnosis and treatment costs

“Before this survey, CHADD occasionally heard from members about difficulties accessing ADHD specialists, diagnostic and therapeutic services, and medications,” the members of the CHADD Public Policy Committee write in the survey’s preliminary report. “We did not know whether these circumstances were the exception or the rule. This survey is helping CHADD to better understand the types of challenges faced by individuals and families with ADHD.”

If you responded to the survey, thank you. Your responses helped to provide needed information to improve the lives of people affected by ADHD. Further analysis will be conducted to break down insurance access according to state and carrier; those results will be distributed in January. The results of the survey will be used by the CHADD Public Policy Committee to help identify the barriers to insurance coverage faced by the ADHD community and to further advocate for better insurance coverage for ADHD and related mental health concerns.

What has been your experience with health insurance coverage for ADHD? Share your thoughts with us