Insurers Are Denying Coverage and Claims For Mental Health

It’s not a surprise to anyone reading this, that our healthcare system – especially when it comes to mental/behavioral health, is beyond broken.  This article I just read in Bloomberg (which I’ll post the link to in “stories”) is perhaps the best breakdown of the major flaws in our system, I’ve come across. 

 

Before even getting into the article, let’s be clear on this major issue: We have a hard enough time getting ppl to open up, talk & then work on their MH & trauma release, bc of stigma, that the LAST thing we need, is to have a system where ppl who finally DO ask for help from practitioners who know what they’re doing, can’t get it, bc of all of the red tape stopping them. 

 

It’s not a hard business principle for us laymen to figure out – insurance companies, their Boards & CEO look to make larger profits year-over-year. They deny claims for “physical” health conditions all the time due to their bottom line goals. But now, with more & more ppl realizing that MH is a “thing” they need to take care of & be on top of, that’s SO much more of a burden on insurance companies than it was in the past, to cover these “extra” doctors visits. 

 

In an effort to try to ensure Insurance companies wouldn’t just keep denying claims, as visits for MH increase, in 2008, congress passed: “The Mental Health Parity & Addiction Equity Act.” It’s an act that requires insurers to provide comparable coverage for mental health & medical treatments. 

 

Sounds great in theory, right? But not even close in practice.

To begin with, the law was passed in the midst of the 2008 financial crisis, & tacked onto the emergency bill that bailed out the U.S.’s failing banks.  These type of “add-ons” happen in Congress all the time…& they are much harder to enforce when they don’t get the coverage the “big bills” do. 

 

After its passing, Insurance companies got together to fight the bill. These companies formed the “Coalition for Parity” that sued to block the law, saying that it would be “unduly burdensome” on them (aka: eating way into their profits). Fortunately, a judge dismissed the challenge on the bill.

 

However, ever since 2008, & losing that suit, insurers are STILL denying claims, limiting coverage, & finding slimy ways to not have to follow the law.

 

The law itself is very loosey goosey too. It doesn’t specifically say how to measure if a health plan’s network of MH providers is sufficient, for example, so the insurance companies have discretion over what they deem is an “adequate network.”

Bc of the loose rules, the insurers are finding subtle ways to deny treatments. Here are examples:

 

1- Their directories of providers are full of doctors who don’t take new patients or are no longer in an insurer’s coverage network. 

2- They request massive amounts of paperwork before approving treatment. 

3- They pay MH clinicians less than other medical professionals for similar services.

4 – Some practitioners who want to join networks are turned away.

 

We have a hard enough time finding trauma-informed specialists who know how to properly treat, & based on all of the above, what incentive do these good docs have to even take insurance?  The end result is growing suicide rates – to the point where the avg life expectancy in the US actually fell each of the last 3 years. 

 

Think about it though – we have a law that’s not very well written or enforced, insurance companies that are doing anything they can to deny payments as more & more ppl open up for help, all while more & more suffer. 

 

I don’t have an answer that’s a quick fix. What I’ll say however is we’ll work w other nonprofits to lobby to make changes. In the meantime, check out the TSRR practices section of our website. In the absence of being able to find & afford great practitioners, there are at-home practices you can do, to work the stress & trauma from your system, naturally. It’s better than waiting for this quagmire to be solved!

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