Insurers accused of denying mental health coverage

Insurers accused of denying mental health coverage | Insurance Business America

Insurers accused of denying mental health coverage

With deaths from suicides and drug overdoses on the rise, insurers are facing considerable backlash for allegedly using red tape to deny claims and limit the coverage of mental health patients.

A Bloomberg report highlighted the case of Max Tillitt, who died at the age of 21 from a drug overdose after his insurer, United Behavioral Health, allegedly denied a longer stay in a treatment center against the advice of his addiction specialist. 

When his mother joined a class action lawsuit against United after Max’s death, she found that red tape had repeatedly denied treatments from mental health coverage across the United States. While a judge ultimately found United Behavioral Health to be liable for breaching fiduciary duty and denying benefits, the case allegedly revealed widespread failures in the mental health system.

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The Mental Health Parity and Addiction Equity Act, a landmark law passed more than a decade ago, requires insurers to provide equivalent coverage for mental health and medical treatments. However, mental health advocates have alleged that insurers use subtle methods to circumvent the rules.

“Health insurers are not following the federal law requiring parity in the reimbursement for mental health and addiction,” President Donald Trump’s commission on the opioid crisis wrote in a 2017 report. “They must be held responsible.”

According to Bloomberg, some of the techniques used to block treatments include padding provider directories with clinics that no longer accept new patients and requesting voluminous piles of paperwork before approving treatment.

“It’ll look like they have all these psychiatrists, but they actually don’t,” Brian Dixon, a child psychiatrist in Texas told Bloomberg. And when Ohio psychologist Melissa Davies examined the directory of health insurer Anthem, she encountered a glaring problem: “I found a great number of their providers were no longer practicing or were dead.”

“You have parity coverage on paper,” Angela Kimball, acting chief executive officer of the National Alliance on Mental Illness, told Bloomberg. “But if you can’t find an in-network provider in your coverage, it can become meaningless for you if you can’t afford care or find it.”

On their end, insurers point to a shortage of mental health experts and a lack of reliable ways to measure quality as contributing to the problem.

“Our members work very hard day in and day out to ensure there is parity between mental health care and physical health care,” Kate Berry, senior vice president of clinical affairs at trade group America’s Health Insurance Plans, told Bloomberg.

More importantly, federal rules don’t provide guidelines on whether a health plan’s network of mental health providers is sufficient. It also doesn’t help that there isn’t a central regulatory body that can define and enforce the rules.

“It’s hard to define who owns this problem when there’s so many different entities and people responsible for enforcement,” Lindsey Vuolo, associate director of health law and policy at the non-profit Center on Addiction, told Bloomberg.