Report Highlights Insurance Denials In MN
By Consumers For Quality Care, on May 15, 2019
In a new investigation, Minnesota’s KSTP highlights a pattern of insurance companies denying coverage for consumers seeking care for mental illnesses. Consumers for Quality Care has previously highlighted how lack of mental health parity can hurt consumers. KSTP’s story comes during Mental Health Month and after a review of medical, state and court records found that insurance companies have routinely denied coverage for mental health-related treatments.
While federal privacy laws make it difficult to know exactly how many patients in Minnesota have been denied coverage, the practice became so problematic at one point that it led to a landmark lawsuit by the state's then Attorney General, a multi-million dollar settlement and widespread reform that led to a drastic decrease in complaints.The deal, brokered in 2002 by then attorney general Mike Hatch, required Blue Cross Blue Shield (BCBS) of Minnesota to pay more than $8 million in fines and “have every denied claim reviewed by an external panel within one business day.” While the deal was only between the state and BCBS, other insurers got the message and complaints about denials plummeted. Now, Minnesota attorneys are saying that insurance denials are trending in the wrong direction again. The attorneys point to a recent class-action lawsuit that refers to an insurer’s guidelines as “fundamentally flawed” and “tainted by financial interests” as evidence. The KSTP investigation highlighted the stories of two young people, Sophia Uhlenkamp and Brooke Mischler, who were denied treatment for eating disorders. After Uhlenkamp was diagnosed with anorexia nervosa, she was in and out of residential treatment. Six months into extensive treatment, BCBS stopped covering treatments, despite the fact she was still struggling to maintain her weight.
"All of a sudden, things weren't automatically covered," [Sophia’s mother], Jeannie Uhlenkamp said.The insurer suggested she go to an “intensive outpatient treatment” program, but there were none within two hours from the Uhlenkamp’s home. Even after a relapse, BCBS denied coverage for the cost of her treatment.
"We couldn't believe it," Jeannie Uhlenkamp said.Brooke Mischler’s parents sued their insurer, OptumHealth, after exhausting appeals to have their daughter’s eating disorder treatment covered. Even after her eating disorder was so severe that she was sent to the ER by her psychiatrist, their insurer refused to cover her treatment.
Elizabeth Wrobel, who represented the Mischlers, specializes in health insurance benefit disputes and said she finds the practice of denying mental health disorders is not limited to a single company. "It's an ongoing problem," Wrobel said.Wrobel adds that she thinks the state is moving backward, instead of forward. She believes that denying mental health coverage has, once again, become a common practice amongst the state’s insurers.