Covering Medication

Filed Under: ADHD and the Law, ADHD Medical Care and Insurance, ADHD and Money

Q:

"My son and I both have ADD. He will need medication for the rest of his life. My plan will no longer cover him after he graduates from high school this spring, and he’s not starting college until the following year. Can he get disability insurance from the government?"

A:

Each state has different policies about insurance coverage and mental health. Many carriers don’t cover medication for conditions such as attention deficit/hyperactivity disorder (ADD/ADHD), because medication does not cure the condition but manages its symptoms.

I would recommend contacting your state’s Department of Insurance to find out how its insurance laws impact the needs of you and your son. You may also look into whether or not your child qualifies for coverage through the university he will be attending, and check whether the law in the state where your son will be going to college includes parity legislation—that is, mental health conditions are covered, just as physical health conditions. If he qualifies, that may resolve the issue.

Many organizations, such as CHADD, NAMI (National Alliance on Mental Illness), and AACAP (American Academy of Child and Adolescent Psychiatry), have been seeking fair treatment for individuals with mental illnesses. A bill passed on March 5 in the House of Representatives (H.R. 1424), and its counterpart in the Senate (S. 558), which passed September 18, require equal coverage for health and mental health/substance abuse treatment. The House bill would cover both in-network and out-of-network services, while preserving state parity laws on state-regulated plans.

Robert Tudisco is a lawyer who specializes in ADHD. He lives in White Plains, New York.
 
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