Insurance Coverage For U.S. Problem Gamblers Yields Mixed Results

July 22, 2022
More U.S. health insurance companies are offering coverage for gambling addiction, but that does not necessarily mean healthcare providers are celebrating.


More U.S. health insurance companies are offering coverage for gambling addiction, but that does not necessarily mean healthcare providers are celebrating.

“Reimbursement times are extremely long with all of them. They deny claims randomly, often for very strange reasons, and they have archaic mental health policies in a lot of cases,” said Daniel Umfleet, the founder and CEO of Kindbridge, a virtual therapy company in Southampton, England, which treats problem gamblers.

Cigna, Blue Cross Blue Shield (BCBS) and Optum are among the U.S. insurance companies that have done business with Kindbridge.

“Each BCBS company is its own independent company and makes its own decisions,” an unidentified BCBS representative told VIXIO GamblingCompliance in an email.

Whatever problems there may be in collecting insurance payments, it is still a sign of progress for gambling disorders to finally be covered like drug addiction and alcoholism.

“It’s long overdue,” said Keith Whyte, executive director of the National Council on Problem Gambling.

“We think the exclusion of gambling by insurance companies has been discriminatory, and based on nothing but outdated stigmas and stereotypes,” Whyte said.

The Diagnostic Statistical Manual of the American Psychiatric Association has listed pathological gambling as a mental disorder since 1980.

Insurance companies began to change their views on gambling addiction after the outbreak of COVID-19 in early 2020, according to Umfleet.

“Insurance companies got on board with tele [health services] real quick, which changed the care access game permanently,” Umfleet said.

Telehealth or teletherapy accounted for less than 1 percent of outpatient treatment before COVID-19. Since then, virtual outpatient care has risen to 13 percent.

“In the mental health field, access through tele is changing the game,” Umfleet said.

The rapid expansion and growing popularity of sports betting in recent years might have been another factor in increased insurance coverage for gambling addiction, according to Whyte.

“Let’s be clear — there’s money to be made now,” he said.

For example, public funding to prevent problem gambling has grown to about $94m.

“Insurance companies, being pretty mercenary, are starting to see they can now tap into these public systems of care,” Whyte said.

The increase is likely to surge even higher, Whyte said, whenever the Food and Drug Administration approves a drug to prevent gambling addiction.

“I think we’ll probably look back in a few years at 2021 and 2022 as an inflection point in the responsible gambling field,” Whyte said.

“Greater coverage by insurance companies reduces stigma and shame and leads to greater public awareness [that] gambling is a big part of our society and culture and still has costs that we need to address in a forthright manner.”

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