Health Insurance Coverage For Epilepsy

Epilepsy is a paroxysmal condition of the brain affecting neurological systems and characterized by a susceptibility to recurrent sporadic seizures. Seizures are events associated with abnormal electrical discharges of neuron in the brain. In most patients, this condition does not affect intelligence, however some episodes can be life threatening. Epilepsy usually occurs in patients younger than age 20, and is believed to be present in an estimated 2% of the population. Most patients achieve and establish control of the disorder with strict adherence to prescribed treatment if insured by a health plan.

Typically, treatment for epilepsy is a combination of multiple therapeutic attempts and protocols systematically managed to either temporarily relieve the patient or terminate epileptic occurrences altogether. Treating epilepsy can be very difficult and expensive which is why being covered by health insurance is essential and necessary to accomplish the means successfully.

This article was created to assist patients diagnosed with epilepsy to obtain health insurance coverage in the individual private healthcare market without the endorsement of limitable riders or attached exclusions on the policy when placed and issued.

There are various methods in clinical practice for treating epilepsy including prescription medications, surgery, and cutting edge experimental procedures. The most commonly prescribed drugs are Phenytoin, Carbamazepine, Phenobarbital, Valproic Acid, and Primidone administered individually for generalized tonic-clonic seizures or complex partial seizures. Valproic Acid, Clonazepam, and Ethosuximide are commonly prescribed as adjunct therapy for partial seizures. Fosphenytoin is an Intravenous preparation that is also effective in treatment.

If drug therapy fails, treatment may include surgical removal of a demonstrated focal lesion to attempt in ending the seizure activity. Surgery is also performed when epilepsy results from an underlying problem, such as intracranial tumors, a brain abscess or cyst, and vascular abnormalities.

Vagal nerve stimulation may also be attempted. A pacemaker with a stimulator lead is placed on the vagus nerve. The nerve is stimulated for approximately 30 seconds every 5 minutes. This procedure is very useful in refractory epilepsy, decreasing seizure frequency and intensity. It has also diminished the need for more medication and increased the quality of life for some individuals.

Transcranial magnetic stimulators are currently under investigation and have been beneficial for some patients. By now it should be clear, insuring this condition is necessary because of the amount of healthcare needed to achieve the goal of treatment.

How The Health Insurance Underwriters View Epilepsy.

Health insurance underwriters are concerned primarily with the associated complications which can occur during the course of a seizure. This may include anoxia from airway occlusion by the tongue or swallowing vomit following traumatic injury. Such trauma could result from a fall at the onset of generalized tonic-clonic seizures such as rapid, jerking movements that frequently occur during or after an episode or from a sudden illicit movement sustained while the patient is confused and has an altered level of consciousness.

In any event, the hesitation to write a policy at reasonable standard rates if at all will be determined by the interrogative stage of screening. In the eyes of a health insurance underwriter it is unpredictability of an epileptic patient that causes concern, as such here are some tips in reference to the screening questions asked to make a proposed applicant appear predictable enough to issue a policy.

Questions Asked by Health Insurance Underwriters on Epilepsy and Tips on Answering Them.

(1) When was the applicant diagnosed with a seizure disorder?

Tip: It is important for underwriters to know how long ago the applicant was diagnosed with the disorder. As a general rule the farther back the better especially if it was diagnosed more than 10 years ago and is being controlled with prescribed medication.

(2) What type of seizure disorder does the applicant have?

Tip: Elaborating to health underwriters is crucial in this regard. Underwriters want to know if an applicant is predisposed to partial seizures, simple partial seizures, complex partial seizures, generalized seizures, mycolonic seizures, generalized tonic-clonic seizures, or akinetic seizures. If status epilepticus is documented on file in claim history, with an incidence requiring hospitalization, a letter of medical clearance from the physician is going to be required.

(3) When was the applicant hospitalized for his or her last seizure?

Tip: The underwriting decision of seizure disorders is in part based on the applicants degree of clinical stability. Most health insurance companies within the individual private healthcare market are requiring last episodes to have taken place with a two year time interval from the date of service when hospitalized in order for consideration of medical clearance. If the last episode happened during the course of the last 24 months an application will have to be submitted to carriers who are more lenient in this regard.

(4) What medications is the applicant currently taking?

Tip: The majority of seizure disorders are treated with medications. In many cases, this involves more than one drug. Seizure control with tolerable side effects can be achieved in up to 80% of patients with only using one prescription, as a general rule the less medication the better a chance to get approved. Some patients may become seizure free without any medications indicating to the underwriter the disorder is not a lifelong condition. Consider weaning the dosage down prior to application submission or receiving the medication during consultation visits with the practitioner instead, this way it appears on record that medications are no longer being used.

(5) Is the applicant employed on a full time basis and in the currently has a valid driver license?

Tip: The severity of a seizure disorder can also be measured in terms of its impact on functional ability. An applicant who cannot work or obtain a drivers license presents serious underwriting concerns for individual coverage. On the other hand, an applicant who is employed full time and has an issued motor vehicle driver license will have an excellent underwriting outcome. The department of Motor Vehicles receives information regarding medical conditions from many sources including accident reports, police reports, and physician reports. In the event there is a revocation or suspension of licensing due to epilepsy ask the physician to provide a certification that the condition is treated and controlled and does not affect driving skills. Many times this simple procedure has overturned many previously denied or substandard rated underwriting decisions and have gotten policies issued with approval at affordable rates.

If you or someone you know is having a difficult time obtaining an approval for major medical health insurance or get an affordable rate because of epilepsy, please visit our website at and leave your contact information. One of our licensed agents will contact you to provide the solution guaranteed.