By Consumers for Quality Care, on May 3, 2023
A family’s desperate attempt to get their daughter critical life-saving treatment for depression turned into a nightmare situation with their insurance provider, according to NPR.
Then 15-year-old Rose suffered from life-threatening depression, anxiety, and chronic suicidality, having already attempted to take her own life several times before her parents, Michael and Rochelle, were able to get her into Rogers Behavioral Health. This facility offered a new type of evidence-based treatment for suicide called Dialectical Behavioral Therapy (DBT), a type of talk therapy intended for individuals with suicidal ideations.
Rochelle recalls what it felt like when they were talking with a therapist at Rogers, recalling that it was “the first connection that I had personally with a therapist who said, ‘I have seen this before. These are the kids that we work with.'”
Rose was going through inpatient care and was showing great signs of improvement. Both her treatment team and her parents were excited and grateful for the progress she was making. But two months into Rose’s time at Rogers, the family’s insurance provider, Medical Mutual of Ohio, decided it would no longer cover her treatment there and instead tried to force Rose to move to a lower level of care.
Michael stated, “It didn’t make sense to me, and more importantly, it made no sense to her treating psychiatrist and the treatment team. They said, ‘it was unworkable, it was extremely dangerous, and would likely lead to a worsening of her symptoms.'”
It is not uncommon for health insurance companies to reject mental health care and treatment claims, according to medical experts and advocates. Meiram Bendat, founder of Psych-Appeal, a law firm that deals specifically with rejected mental health care insurance claims, stated, “This goes back to a long history of discriminating against mental illnesses, patients with mental health disorders.”
Further complicating Rose’s care was the use of prior authorization by Medical Mutual and their continued attempts to move her to “lower level” care, such as virtual DBT sessions, even though Rose’s treatment team suggested that she could attempt suicide again. Medical Mutual kept telling the family the company had “never approved” such “a long treatment” plan before, and repeatedly attempted to impose time-based expectations. One medical expert compared this method of treatment akin to sending a patient who had a heart attack home while they were still having chest pains.
After Medical Mutual ended coverage of Rose’s treatment program at Rogers Behavioral, Michael and Rochelle paid $40,000 out-of-pocket before they ran out of money and Rogers had to “fast-forward” her release from the program. Just two and a half weeks later, Rose made another attempt on her life.
Michael filed an appeal with the Ohio Department of Insurance over the denial of coverage and ended up winning nine months later. Rose is 17 now and improving, but still struggles with depression and anxiety.
CQC calls on lawmakers and providers to reform the prior authorization process by eliminating barriers that prevent consumers from accessing the medical care they need. CQC also urges lawmakers to make mental health services more accessible for all consumers. If you or someone you know is struggling, there are resources to help. Call the National Suicide Prevention Lifeline at 988 or reach out to the Crisis Text Line by texting HOME to 741741.