While it is easy to bash insurance companies for their stingy ways, in this instance the problem starts with the American Psychiatric Association. In the first four editions of its highly influential Diagnostic and Statistical Manual of Mental Disorders, the APA identified pathological gambling as an impulse control disorder, on par with such conditions as pyromania, kleptomania and compulsive shopping. Impulse control disorders have never been covered by health insurance policies, and overlooking gambling addiction was easy as long as it remained misclassified.

Finally, in the latest edition of the APA’s definitive publication (DSM-5), pathological gambling has been moved to the addiction section, where it is listed as a “non-substance related disorder.” This is in line with all of the latest research, which has uncovered numerous neurological and behavioral similarities between gambling addiction and alcoholism and drug abuse. Pathological gambling is a brain disease that destroys lives as surely as any other addiction, and those who suffer from this condition need help to overcome it.

But as of yet, the law has not caught up with the latest medical findings. Neither health insurance companies nor disability insurers, public or private, have adjusted their approach to include pathological gambling among the types of injury or illness that are eligible for coverage or compensation. And state laws in this area are ambiguous, failing to force the hand of insurance companies by requiring them to recognize gambling addiction as a legitimate form of mental illness. Federal antidiscrimination laws do apply to insurance companies and their dealings with their customers, but those with gambling problems have never been sheltered beneath this particular protective umbrella.

It is not absolutely unheard of for insurers to cover the costs of treatment for gambling addiction. And on occasion, those who file disability claims because of chronic pathological gambling do gain positive results. While laws haven’t required gambling coverage, there is nothing in the rules that prevents insurance companies from covering the condition, and in some instances they have chosen to do so. But this type of forward thinking is still relatively rare, and lawsuits attempting to force insurance companies to extend benefits based on gambling-related claims have almost always failed.

Given its recent adaptation, one would think the Affordable Care Act might address these unfortunate discrepancies. But despite demanding quality coverage for substance abuse and mental health treatment, the act’s framers largely neglected gambling addiction. Overall coverage here is spotty: some ACA policies will compensate gambling addiction treatment providers but others will not—and government bureaucrats don’t appear to be in any hurry to alter this situation.

The real problem is that ACA rules were crafted before the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was issued. The ACA ensures that “essential health benefits” will be provided to policyholders, but impulse control disorders are not included under this label, and according to presently existing standards, pathological gambling is still considered to be one of these.

What Every Insurance Company Should Know: Gambling Addiction Is Addiction

The good news is that many states make public monies available for gambling addiction treatment. But without an expansion of insurance coverage, it will be impossible to expand the availability of rehabilitation services any time soon. Extra private funding for treatment would make it easier for government health departments to train and hire more therapists who specialize in gambling disorders, meaning that waiting lists could be shortened and more gambling addicts could be helped. Budget reallocations would also give anti-gambling educational campaigns access to the money they need to make a much larger impact.

Public awareness of gambling’s deprivations is lacking, and significantly. Most Americans would be surprised to learn that as many as 6 million of their fellow citizens meet the criteria for pathological gambling. By any definition of the word that makes sense, gambling addiction is a disease, and it should be included on the list of mental health disorders that health insurance automatically covers.


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