?

Log in

No account? Create an account
Ys
ysabel
..:: .::: .:: .::.::.:.: .. ..:: .::: .:: ....

May 2011
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31

Ys [userpic]

I cannot begin to express how irritating it is that some insurance companies do things like exclude all coverage for treatment of adult ADD/ADHD.

I'm waiting for some insurance company to get the bright idea that they can exclude coverage of treatment for illness or injury, and yet probably still get people (and companies) to buy the insurance.

Tags:
Current Mood: pissed offpissed off
Comments
Huh

I went to the "providers" section of the Blue Cross/Blue Shield page (ours is the nationwide program and has an odd habit of considering things "investigational" when every other insurance company in the country will pay it), and didn't find "adult ADD", just this:

CAM 30101

Attention Deficit Disorder (ADD)
Category: Mental Health Last Reviewed: December 2006
Department(s): Medical Affairs Next Review: December 2007
Original Date: December 1995

Description:
Attention deficit disorder (ADD) is classified as a state characterized by a persistent pattern of inattention or hyperactivity-impulsivity.

Inattention may be manifest in academic, occupational or social situations. Individuals with this disorder may fail to give close attention to details or may make careless mistakes in schoolwork or other tasks. Work may be messy and performed carelessly and without considered thought.

Attention deficit disorder can be subdivided into inattention with hyperactivity and inattention without hyperactivity or impulsivity.

Hyperactivity may be manifested by fidgetiness or squirming in one’s seat, by excessive running or climbing in situations where it is inappropriate, by having difficulty playing or engaging quietly in leisure activities, by appearing to be often "on the go" or by talking excessively.

Impulsivity manifests itself as impatience, difficulty in delaying responses, blurting out answers before questions have been completed, difficulty awaiting one’s turn and frequently interrupting or intruding on others to the point of causing difficulties in social, academic or occupational settings.

Policy:
Attention deficit disorder is classified as a Mental Health condition. Stimulant medication is MEDICALLY NECESSARY in the treatment for attention deficit disorder. Behavioral management is helpful in some cases, but not required.

Policy Guidelines:
Evaluation prior to the diagnosis of attention deficit disorder is considered MEDICAL.

Edited at 2007-11-16 06:10 pm (UTC)

Re: Huh

From the Schedule of Benefits for J's new provider, which is Blue Cross/Blue Shield, in the exclusions list:

18. ADD/ADHD drugs for individuals nineteen (19) years of age and older
It's one of the things he missed in calculating the pay change when he switched jobs; ADD meds for J and A together are an extra few hundred bucks a month if we have to pay for them ourselves. The new company's old provider had the same exclusion, and we were hoping it would go away with the switch to BCBS, but clearly the company is unwilling to pay for coverage that would cover it.

We're used to having to jump through hoops to get coverage, that's fairly normal. But having it listed in the exclusions like that is new to us.

Re: Huh

Ours is technically BCBS of Florida (go figure), and I can't find anything on the drug list that excludes age other than Retin-A for people over 30. Which means, of course, that it's probably buried somewhere and we wouldn't find out about it until we tried to buy the medication. They're sneaky like that.

...see if you can get insurance from an out-of-state provider. In Washington,, the companies have figured out that their employees are their only assets, and take no crap from insurance providers.

As a result, there are now providers that try hard to work with you. Who would have thought?