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

• Published in: Pediatrics (Evanston) 2009-01, Vol.123 (1), p.191-196
• Main Author: Committee on Adolescence and Committee on Child Health Financing
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent health services; Advisory Committees - standards; Advisory Committees - trends; Biological and medical sciences; Child; Delivery of Health Care - methods; Delivery of Health Care - standards; Delivery of Health Care - trends; General aspects; Government regulation; Health Behavior; Health insurance; Health services; Humans; Insurance coverage; Insurance, Health - standards; Insurance, Health - trends; Laws, regulations and rules; Medical sciences; Medically Uninsured; Miscellaneous; Payments; Pediatrics; Pediatrics - methods; Pediatrics - standards; Pediatrics - trends; Prevention and actions; Preventive Health Services - methods; Preventive Health Services - standards; Preventive Health Services - trends; Preventive medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reproductive Medicine - methods; Reproductive Medicine - standards; Reproductive Medicine - trends; Teenagers; Underinsurance
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2008-3308

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.