From: Dr. Pat Ryan [mailto:pjrphd@verizon.net] 

Sent: Thursday, May 28, 2009 10:38 PM 

To: EBSA, E-OHPSCA - EBSA 

Subject: Fwd: Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008

May 28, 2009 10:30:21 PM, pjrphd@verizon.net wrote: 

Dear Sir or Madam: I am a licensed clinical psychologist who provides neurofeedback 

treatment and to individuals with Attention Deficit Hyperactivity Disorder, Mood Disorders, 

Insomnia, Migraine sufferers, as well individiuals with other severely limiting mental health 

conditions. Many of these clients cannot access their insurance coverage because it is 

identified as "not medically necessary". Neurofeedback is an empirically validated and widely 

recognized effective non-medication treatment for ADHD, as well as other conditions. There 

are over 50 studies evaluating the effectiveness of neurofeedback in the treatment of ADHD, 

substance use disorders and Autism. A recent review of this literature concluded 

"Neurofeedback meets the American Academy of Child and Adolescent Psychiatry criteria for 

Clinical Guidelines for treatment of ADHD." This means that neurofeedback meets the same 

criteria as medication for treating ADHD, of which 60% of prescriptions are in fact prescribed 

"off label," and that neurofeedback "should always be considered as an intervention for this 

disorder by the clinician." 

This service has been denied by Florida Medicaid, Aetna, United Behavioral Health, Blue 

Cross/Blue Shield, and most small insurance carriers. 

 

This is limitation of an effective and validated treatment for a mental health problem. 

The reasons given by the insurance companies for this denial fell into two categories: 1) 

our company does not cover biofeedback for mental health problems or 2) there is not yet 

sufficient evidence for the efficacy of neurofeedback. As such, they are using evidencebased criteria that are far more restrictive for mental health services than the criteria 

which are used for medical/surgical services. There are many routine medical and surgical 

procedures which have far fewer controlled studies about their efficacy than does 

neurofeedback. These medical and surgical procedures are generally not limited because 

of concerns about how many controlled studies have been performed about them. 

Neurofeedback, is an operant conditioning process of biological mechanisms. There is a 

huge body of research over the last 50 years that demonstrates that operant conditioning 

can, in fact, positively alter biological functions. Moreover, burgeoning findings in pure 

neuroscience suggest that we are on the track to developing treatments like 

neurofeedback that are environmentally safe, free of negative side-effects if properly 

delivered, and is highly likely to be a cost effective preventive measure. 

We, as practitioners, believe that the parity regulations, based on legal reviews of the 

parity statute should require that employers and plans pay for the same range and scope 

of services for behavioral treatments as they do for medical surgical benefits and that a 

plan cannot be more restrictive in their managed care criteria and reviews for mental 

health and substance abuse disorders when compared to medical surgery. Today, 

insurance plans are being more restrictive in how they review evidenced-based mental 

health and Substance Abuse Treatments when compared to medical surgical treatments. 
This violates both the intent and letter of the parity statute and we hope that the 

regulations will clarify that this can't continue. 

 

Patricia Jo Ryan, PhD Licensed Florida and New York Psychologist