Loopholes leave gaps in mandatory mental health coverage

“It was a real surprise,” said the father, who asked to be identified only by his middle name, Paul, to protect his family’s privacy. “T...


“It was a real surprise,” said the father, who asked to be identified only by his middle name, Paul, to protect his family’s privacy. “They had never seen this before.”

West Virginia lawmakers have since passed legislation requiring parity for coverage of mental health and substance abuse disorders, although the plan covering the doctor still operated under exemption in the most recent government lists. State plan officials did not respond to requests for comment.

Even relatively inexpensive treatment can be difficult to obtain. In Chicago, one of Dr Michael’s former patients, Julia, whose husband worked for the city and asked not to be identified by his last name to protect his family’s privacy, compared the coverage in recent years. years to deal with his anxiety.

Unlike her previous policy with another Blue Cross plan, a new plan overseen by an outside company required hefty pre-approvals for therapy, she said. She was to provide detailed information that had previously been provided by her therapist, including the exact diagnostic code and the so-called NPI number used to identify the provider. The company started approving fewer visits at a time, she said.

“It just requires you to jump through the hoops, recall and keep track,” she said. If you missed a clearance, you had to pay the full cost of the session.

She also said she had come under pressure to estimate how long treatment would last or when it might end, a sought-after timeline in stark contrast to any questions about her other medical conditions. “I don’t need to get pre-approved for my dermatology appointments,” she said. “Rosea will never leave. No one asks my dermatologist to treat rosea.

She stopped therapy when she felt she could manage her condition adequately.

Advocates and patients say law enforcement has often been lax and many insurers and employers refuse to pay for expensive mental health treatments. But the involvement of state and federal regulators in the $ 14 million settlement with United “is very important,” said D. Brian Hufford, lawyer at Zuckerman Spaeder, whose firm represented individuals in private lawsuits. His firm also represented the plaintiffs in another lawsuit against United which resulted in a decision of 2019 against the company in which a Northern California federal judge said one of his units created internal policies to effectively discriminate against patients to save money. United said the care provided to its customers was appropriate and the case is now on appeal.

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Newsrust - US Top News: Loopholes leave gaps in mandatory mental health coverage
Loopholes leave gaps in mandatory mental health coverage
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