Why do some health care plans cover a life-time supply of psycho-stimulant medication for ADD/ADHD but deny patients coverage for the vision development and rehabilitative therapy that will correct the cause of the ADD-like behaviors rendering the patient medication free?
Let’s get right to the point. There are 2 highly recognized diagnoses of the visual system that routinely result in ADD/ADHD behaviors.
The first is known as Convergence Insufficiency
The second is known as Accommodative Disorder
Dr. Press and I have written about both of these visual entities extensively on the VisionHelp Blog and for more information just click on the “linked” words above.
Furthermore, there is sufficient clinical trial research to show that both of these conditions are successfully treated with office-based vision therapy as outlined in the links.
So why write a post that is a rehash of what has been written before? Like many of my posts, this one was inspired by a patient. The scenario presented to me last Friday. One of our patients, a 13 year old girl with a serious convergence insufficiency in conjunction with an accommodative disorder and struggling with classic ADD-like behaviors plus headaches and fatigue with reading. Her PCP diagnosed her with ADHD and tried a variety of medications but nearly all, especially the stimulant medications gave her many negative side effects and did not address her visual dysfunctions. Yet, her health insurance is saying “yes” to the drugs but “no” to treating the sensory motor dysfunction of her visual system with vision therapy!
Why would a health insurance policy cover the patient with ADD/ADHD medications but to deny treatment for the very thing that is causing the ADD/ADHD behaviors- Convergence Insufficiency and Accommodative Disorder? Well possibly it is because they just do not have the current research and therefore the facts are needed to set the record straight.
To this I’m responding on behalf of our patient with an appeal that will include the research that provides substantial evidence for supporting this patient’s treatment. But, knowing that if this is happening to our patient, it is also happening to others around the country, I’m providing the following peer reviewed scholarly research papers in this post to help others who may be experiencing the same problem. Here are 3 papers to provide the research documentation to support the necessary treatment.
Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD
Yes, it is important to recognize that not all ADD/ADHD is caused by a visual problem, and with that understanding, there clearly can be a place for psychostimulant medications for those individuals with a biochemical cause for their symptoms. However, it is absolutely critical to the health and well being of those with a visual problem such as convergence insufficiency and/or accommodative disorder not to be mistaken for ADD/ADHD and obtain the proper “drug-free” office-based vision therapy treatment to correct the underlying cause of the problem.
Dan L. Fortenbacher, O.D., FCOVD
The VisionHelp Blog 
Thank you, Dan! This will be helpful for those skeptical patients, as well as insurance companies! T
This is so very important to children who have been diagnosed with ADD but in fact have ocular motor and accommodative disorders contributing to their reading/learning disability. We need to keep educating teachers, insurance providers, and parents so that these children will not be left behind, and left with poor opinions of themselves and their abilities.
Nicely put!