ADHD and ADD Insurance Denials

According to a November-December 2023 National Center for Health Statistics (part of the CDC) survey of the 7.8 percent of American adults ever diagnosed with ADHD, ages of diagnosis broke down as follows: 36.2% at 11 or younger, 14.1% at 12-17, 15.1% at 18 to 24, 25.5% at 25 to 44, and 9.1% at 45 or older. Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are among the most common neurodevelopmental disorders of childhood. Children with these disorders may have trouble paying attention, controlling impulsive behaviors, or exhibiting overly active (hyperactive) behaviors. While it is normal for children to exhibit these behaviors during their childhood, children with ADHD and ADD exhibit the behaviors on a regular basis and carry those behaviors into adulthood. Children with ADD or ADHD may:

• Have difficulty getting along with others
• Daydream often
• Make careless mistakes
• Lose things
• Be unable to pay attention to details
• Be easily distracted
• Have difficulty resisting temptation
• Forget things often
• Fidget or squirm—cannot sit still
• Forget details of daily routines
• Speak at inappropriate times
• Have trouble taking turns
• Talk incessantly
• Take unnecessary risks

The risk factors for ADHD and ADD are unknown, but research has shown that genetics play an important role in these disorders. It can be extremely disheartening—once you have found a doctor who correctly diagnosed your child and is recommending specific treatments for ADHD and ADD—to receive an insurance denial.

Page Contents:

• Why ADHD and ADD Insurance Claims May Be Denied
• What Can You Do If Your Health Insurance Claim is Denied?
• Specific Insurance Companies That Are Known to Deny Treatments
• What Drugs and Treatments Are Commonly Prescribed for ADHD and ADD?
• How Can an ADD or ADHD Insurance Denial Affect Your Life?
• How the Law Offices of Scott Glovsky Can Help

Why ADHD and ADD Insurance Claims May Be Denied

Most ADHD and ADD testing are covered by health insurance plans under mental health. Psychological evaluations and cognitive assessments measure behavior, attention span, memory skills, problem-solving abilities, and other areas that might indicate hyperactivity or inability to pay attention. Neuropsychological evaluations for ADHD and ADD involve more detailed brain scans and may receive an insurance denial. ADHD or ADD insurance claims for testing, treatments, or medications may be denied for a variety of reasons.

Your insurer may deny the claim because the form was improperly filled out or incomplete. This is usually easy to fix, and the claim can be resubmitted. In some cases, a claim could be denied because the treatment or medication is specifically excluded, or prior authorization was not sought. However, if your claim is denied because the insurance company claims the treatment or drug is experimental, investigational, or not medically necessary, you need to speak to a knowledgeable insurance denial attorney from the Law Offices of Scott Glovsky.

What Can You Do If Your Health Insurance Claim is Denied?

If you’ve received an insurance denial for an ADHD or ADD treatment, you have many options. You can file an internal appeal, which essentially asks the insurer to reconsider its decision. You can submit a letter from your doctor detailing why the drug or treatment is necessary, or if your internal appeal is denied, you can file an external appeal. During an external appeal, a third party will decide whether your insurer must pay for the ADHD or ADD treatment or medication. Before filing an external appeal, however, we recommend that you speak with a qualified health insurance attorney because this lawyer may suggest that you follow a different path.

Specific Insurance Companies That Are Known to Deny Treatments

While any insurance company may issue ADHD and ADD insurance denials, some companies may be more likely to do so. These companies include:

• Anthem Blue Cross
• Blue Shield
• Kaiser
• UnitedHealthcare
• Aetna
• Others

What Drugs and Treatments Are Commonly Prescribed for ADHD and ADD?

Behavioral therapies and stimulant drugs may be used alone or in combination to treat children with ADHD and ADD. Most studies have found that a bit more than three-quarters of the children treated with ADHD and ADD drugs experience improved symptoms once the right medication and dosage are found.

Studies show that about 80% of children with ADHD who are treated with stimulants improve a great deal once the right medication and dose are determined. Ritalin and Adderall are the most well-known ADHD and ADD drugs, however, others in this category include:

• Dextrostat
• Focalin
• Methylin
• Metadate CO
• Adderall-XR
• Vyvanse
• Concerta
• Daytrana
• Focalin XR
• Quillivant XR
• Intuniv
• Kapvay
• Straterra

How Can an ADD or ADHD Insurance Denial Affect Your Life?

An insurance denial for an ADHD or ADD treatment can cause frustration, even anger. If you or your child has been prescribed an ADHD or ADD medication or behavioral treatment that your doctor believes will significantly improve symptoms of the disorder, yet your insurer has issued a denial, you need a strong advocate in your corner who will fight for you, your rights, and your future. You pay your insurance premiums faithfully, jumping through every hoop your insurance company requires. For the company to now deny a necessary treatment or medication is an affront, and one that the Law Offices of Scott Glovsky can help you with.

How the Law Offices of Scott Glovsky Can Help

If your insurance company has denied your ADHD or ADD prescription drug or treatment, attorney Scott Glovsky understands just how devastating such a denial can be. Scott has spent a good part of his life fighting for justice against big insurance companies that believe they can’t be touched. When you choose the Law Offices of Scott Glovsky, you can expect to no longer feel as though you are fighting a losing battle all by yourself. Scott Glovsky and his legal team fight for justice every single day for every single client. We remain fully committed to you and your case, taking responsibility for potentially being your last chance to get the justice you deserve very seriously. Contact the Law Offices of Scott Glovsky today.