As Suicides Rise, Insurers Find Ways to Deny Mental Health Coverage

[RandySF]

The U.S. is in the midst of a mental health crisis. In 2017, 47,000 Americans died by suicide and 70,000 from drug overdoses. And 17.3 million adults suffered at least one major depressive episode. The Mental Health Parity and Addiction Equity Act, a landmark law passed more than a decade ago, requires insurers to provide comparable coverage for mental health and medical treatments. Even so, insurers are denying claims, limiting coverage, and finding other ways to avoid complying with the law.

Americans are taking to the courts to address what they see as an intrinsic unfairness. DeeDee Tillitt joined one lawsuit in 2016, months after she lost her son Max. He’d been an inpatient for three weeks at a treatment center to recover from a heroin addiction and seemed to be making progress. His addiction specialist wanted him to stay. United Behavioral Health, a unit of UnitedHealth Group, the nation’s largest insurer, declined to cover a longer stay for Max. Reluctantly, his family brought him home. Ten weeks later, Max was dead of an overdose. He was 21.

Tillitt soon discovered that Max’s death wasn’t an isolated tragedy. Across the country, people who need mental health and addiction treatment encounter roadblocks to care that could save their lives. United Behavioral Health was already the target of a class action alleging that it improperly denied coverage for such treatment. UnitedHealth’s headquarters is in the Minneapolis suburbs, not far from where Tillitt lived. She says she spent hours on the phone getting passed from one rep to another in her quest to find Max care the insurer would cover. “I felt like, God, could I just drive down to the lobby and scream at them?’ ” she says.

Tillitt became part of the suit against the company in February 2016. In March of this year, a judge found United Behavioral Health liable for breaching fiduciary duty and denying benefits, saying the insurer considered its bottom line “as much or more” than the well-being of its members in developing coverage guidelines. United Behavioral Health says it’s changed its guidelines and that “our policies have and will continue to meet all regulations.” In May the company asked the court to decertify the class, which would mean only the named plaintiffs would be eligible for remedies.


https://www.bloomberg.com/news/features/2019-05-16/insurance-covers-mental-health-but-good-luck-using-it

[spooky3]

1. Here is a less dramatic but just as serious problem:

https://www.fiercehealthcare.com/payer/low-reimbursement-rates-from-private-payers-to-mental-health-providers-may-curb-patient

Reimbursement rates are so low that many if not most mental health providers will not accept insurance or sign on to be in-network. If people can’t get coverage, they just won’t seek help because they can’t afford it.

I have a friend who is a counselor; she said the standard insurance reimbursement wouldn’t even cover her out of pocket expenses (eg office space, phone, malpractice insurance) let alone pay her a salary.

[mnhtnbb]

3. Before anyone starts up with Medicare for all,

Medicare is not much better. My husband was a psychiatrist ( who ended up committing suicide) but he was unique in our community. Most of the psychiatrists did not bill insurance. You paid them and then submitted the claim to your insurance company. My husband went through the arduous process of setting up billing so he could bill Medicare for his patients who had it. He was the only psychiatrist in our community (to our knowledge) who would do that.

He was semi retired at the point when he started billing for his Medicare patients which only paid about half his normal hourly rate. He was on Medicare himself and thought it was the right thing to do, but he still didn't bill private insurance just like his colleagues in the community.

We both supported the concept of single payer and he belonged for years to the Physicians for National Health Program.

http://www.pnhp.org/open/

[smirkymonkey]

2. K&R

[cbdo2007]

4. Addiction treatment is tough because there a ton of...

Unlicensed places out there that trick the patient by pretending they are in network when really they aren't, and by using nontraditional ways to treat addiction. Then the person doesn't get better and the place bills the patient for $100,000 and they haven't learned to manage their addiction correctly.

Addictions don't get healed, it's about learning to manage it with a follow up plan of medications, therapy visits, and a support system at home...none of these things are provided by these fancy addiction recovery places in advertisements on the Florida and California coast.

[Initech]

5. Such a conservative thing to do. Drive people to the brink of madness...

Then deny them coverage for a pre-existing condition. There is no end to their evil.