Underinsurance of Adolescents: Recommendations for Improved Coverage of Preventive, Reproductive, and Behavioral Health Care Services

Abstract

The purpose of this policy statement is to address the serious underinsurance (ie, insurance that exists but is inadequate) problems affecting insured adolescents' access to needed preventive, reproductive, and behavioral health care. In addition, the statement addresses provider payment problems that disproportionately affect clinicians who care for adolescents.Among adolescents with insurance, particularly private health insurance, coverage of needed services is often inadequate. Benefits are typically limited in scope and amount; certain diagnoses are often excluded; and cost-sharing requirements are often too high. As a result, underinsurance represents a substantial problem among adolescents and adversely affects their health and well-being.In addition to underinsurance problems, payment problems in the form of inadequate payment, uncompensated care for confidential reproductive services, and the failure of insurers to recognize and pay for certain billing and diagnostic codes are widespread among both private and public insurers. Payment problems negatively affect clinicians' ability to offer needed services to adolescents, especially publicly insured adolescents. Pediatrics 2009;123:191-196 INTRODUCTIONHaving health insurance has been associated with better access and utilization of health care, whereas uninsured families are more likely to report experiencing "unmet" health care needs for their children and adolescents. 1,2 In 2006, 13.8% of adolescents 13 through 18 years of age and 28.4% of older adolescents aged 19 through 21 were uninsured. 3 Adolescents at greatest risk of being uninsured are older, are Hispanic, and have low household income. The problems of uninsured adolescents have been a long-standing concern of the American Academy of Pediatrics (AAP) and the subject of several policy statements 4-6 and ongoing state and federal advocacy efforts.Having health insurance that provides comprehensive and affordable coverage for preventive, behavioral, and reproductive care is particularly important for adolescents, because the major causes of morbidity and mortality in this age group are related to injuries from motor vehicle crashes, suicide, interpersonal violence, alcohol and drug use, and risky sexual behaviors. This policy statement presents a series of recommended strategies to address the serious underinsurance and payment problems affecting insured adolescents and the clinicians who care for them.

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