Insurance Companies Exceed Expectations Most People Assume Gambling Addiction Isn’T Covered, And Health Insurance Firms Say They’Re Not Sure Why

Two weeks after representatives of three insurance companies dropped the surprise news that they would cover treatment for gambling addiction, there is still puzzlement over why it caught anyone off guard.

“Why was it such a surprise?” asked Dean Barber, a manager with Regence Northwest Health. “That is a good question. I guess I was a little surprised that it was such a surprise.”

It has been a common assumption that insurance companies provide little or no coverage for people seeking treatment for a gambling addiction.

A treatment program started at Deaconess Medical Center earlier this year was launched partially over concerns about a lack of coverage.

“While this whole insurance issue can appear embarrassing, the fact is it was never corrected when it was discussed,” said Mike Forness, manager of Deaconess Medical Center’s behavioral medicine program.

Forness and others in the treatment community aren’t dwelling long on embarrassment. More important to them is that people who need help will be able to pay for it.

“If this hadn’t have happened we would have continued under this mistaken impression that it wasn’t covered,” Forness said.

And while three insurance companies have said they will cover treatment, gambling addiction remains an illness that can leave people penniless and without insurance coverage, Forness said.

While only a small percentage of people who gamble get addicted, a 1999 Washington state lottery-funded study estimated that there could be 53,000 to 138,000 adults in the state with a problem.

Since Deaconess started its treatment program in March, roughly half of the 44 clients have had no insurance coverage.

The issue of insurance coverage came up during a Senate gambling panel hearing in Spokane. The three insurance companies represented all cover treatment as long as their policy has a mental health benefit.

However, a survey done by the Office of the State Insurance Commissioner showed that treatment providers sometimes take a “back-door” approach to getting coverage from other insurance companies.

“They say they can’t file a claim specifically for gambling addiction, so they file under some associated condition. Gambling addiction always occurs with some other problem, such as depression,” said Jennifer McCausland, a legislative liaison for the insurance commissioner.

The situation can be even more complicated than that, said Charles Maurer, a Ph.D. clinical psychologist in Seattle and president of the National Council on Problem Gambling.

Maurer has never taken the back-door approach - he considers it unethical - but he has submitted claims to insurance companies that specifically exclude treatment for gambling addiction and then had them paid.

Regence Northwest Health, Group Health Cooperative and Premera Blue Cross all provide coverage if gambling addiction is listed as the primary diagnosis.

One explanation for the misconception that insurance companies don’t cover the treatment is that it’s unlikely most policies specifically name it.

“I don’t think we define all the illnesses covered under our mental health benefit,” Barber said. “We list what is specifically excluded. To list what is included would be pages and pages.”

The three insurance companies have very few claims for gambling addiction treatment.

Though surprised by the news, the Washington State Council on Problem Gambling is pleased. The council’s director, Gary Hanson, has frequently said there is little or no insurance coverage. No one has ever corrected him.

“I think we’re going to put an article on this in our next newsletter,” Hanson said. “The fact that they don’t have many claims tells me a lot of people don’t even know about this.”

His opinion was echoed by Henry Montgomery, clinical supervisor for Deaconess Behavioral Medicine.

“I think there needs to be a lot of education out there about this,” Montgomery said. “I think a lot of clinicians are just sure no insurance company would pay for it. It is not widely known.”