In Special Needs News

Many insurance companies are routinely denying doctor requests that patients receive coverage for inpatient psychiatric treatment, sometimes with disastrous consequences, according to a recent investigative report by the CBS News show 60 Minutes.  

Before the Affordable Care Act (ACA, aka “Obamacare”) passed in 2010, insurance companies often discriminated against mental health patients by requiring higher premiums and co-payments for mental health treatment and psychiatric drugs than for treatments for physical ailments.  The ACA includes mental health parity provisions requiring insurance companies to treat all patients equally, including mental health patients, meaning that companies may no longer charge different co-pays for psychiatric care or inpatient psychiatric hospital care.

According to 60 Minutes, while post-ACA insurance plans now meet these mental health parity requirements on paper, in practice many insurance companies routinely deny requests for inpatient treatment for psychiatric illnesses.  The report highlights several reviewing doctors who work for Anthem Health, which denied between 90 and 100 percent of physician requests for inpatient treatment.  In one case, a health insurance psychiatrist who reviewed 550 cases a month denied coverage when the patient’s treating physician failed to call him back within 54 minutes of his first phone call.  60 Minutes also uncovered several instances in which psychiatric patients were discharged from inpatient facilities prematurely and ended up dying shortly thereafter.

The 60 Minutes report highlights the problems with implementing mental health coverage after the ACA’s passage.  While it is important that mental health parity laws exist, it has become clear in recent years that insurance companies will attempt to work around the existing regulations to deny necessary coverage for mental health patients, even though the actual plans appear to treat all patients equally.  If your family is experiencing problems obtaining mental health care, talk to your special needs planner about your options.

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