From: Matthew Fleischman PhD [mailto:matthew@attentionlearning.com] 

Sent: Thursday, May 28, 2009 6:00 PM 

To: EBSA, E-OHPSCA - EBSA 

Subject: Parity for neurofeedback

I am a licensed psychologist in Oregon who provides neurofeedback treatment to individuals 

with Attention Deficit Hyperactivity Disorder and Mood Disorders. 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." I would add that 90% of my 

clients respond extremely well to this treatment and that I most of my referrals from other 

patients and their parents. 

 

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

Cigna, and Amerigroup. There are several studies showing that most clients stop taking 

prescribed stimulants within 3 years even though the problems are not resolved. 

Neurofeedback treatment has been shown to be lasting and yet these insurers only support the 

use of medication. Because ADHD is a chronic condition to which they are offering only a 

temporary solution, they are not addressing the basic issue with the treatments they support. 

 

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 evidence-based 

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. 

 We 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 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.