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Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage. (www.propublica.org)

submitted 1 week ago by BrikoX@lemmy.zip to c/usa@midwest.social

33 comments fedilink hide all child comments

Providers, patients and even some federal judges say progress-based insurance denials harm patients at key moments of mental health treatment.

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[–] Australis13@fedia.io 88 points 1 week ago (2 children)

Honestly, I have to wonder if the cruelty is the point here. Even in the cold light of pure financial terms, it's bad for insurers to behave this like:

Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.

During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.

A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.

[–] varyingExpertise@feddit.org 8 points 1 week ago (1 children)

Likely some internal incentive program that rewards certain minimum rejection rates. Costs following that are counted elsewhere.

[–] Australis13@fedia.io 5 points 1 week ago

I can definitely believe that. The whole "not my specific budget, not my problem" thing.

[+] Encode1307@lemm.ee -49 points 1 week ago (5 children)

[deleted]

[–] araneae@beehaw.org 18 points 1 week ago

Boot licker.

[–] irotsoma@lemmy.world 17 points 1 week ago* (last edited 1 week ago) (1 children)

Same thing that most people say about antibiotics. I don't need to finish this, I'm getting better now, and then they relapse and the antibiotics don't work the second time around. Stopping the treatment of a disease when the patient just begins recovery rather than allowing the patient to fully recover is always bad and sometimes means the second try will be that much more difficult as they are traumatized by the poor result of the previous try. "Fine" is not recovered. I was "fine" for 40+ years with undiagnosed ASD and ADHD, because I learned to mask so I appeared "fine". But really I just had to end treatment every time before prior to finding the root causes.

[+] Encode1307@lemm.ee -14 points 1 week ago (4 children)

[deleted]

[–] bane_killgrind@slrpnk.net 11 points 1 week ago (1 children)

They aren't doctors, or they aren't the patient's doctor. They sometimes don't even have a specialization in the treatment they deny coverage for.

Completely unqualified.

[–] irotsoma@lemmy.world 7 points 1 week ago

Only the criteria here was, "You have made progress." And "You are not a danger to yourself or others.". There is no condition about having to be at a point where you are no longer making progress, only that the person is no longer suicidal/homicidal at the current stage of progress. This isn't at all saying the patient wouldn't benefit from further therapy. That's not a condition for the "medical necessity" in this case. If your only criteria is that the person is somewhat improved and not in an emergency situation, then there is a high likelihood of regression upon cessation of medical intervention in any field of medicine. Hoping that they'll be able to get help again before they become suicidal/homicidal again is not a strategy and usually ends in tragedy. Most times they don't even bother to seek help. This case the person went to the ER, but often that's not going to happen if the person considers the cost of the Ambulance, ER, and hospitalization on top of the mental energy required to make the call and then explain your whole history to someone new and then justify your need for the services. It's unreasonable to expect a good outcome the more times the person has a bad outcome.

[–] Maggoty@lemmy.world 6 points 1 week ago (1 children)

That is utter bullshit.

[–] HellsBelle@sh.itjust.works 5 points 1 week ago (1 children)

Where's your stats and data that back that up??

[–] AtariDump@lemmy.world 7 points 1 week ago

Narrator: They didn’t have any.

[–] CileTheSane@lemmy.ca 10 points 1 week ago (1 children)

Source?

[–] CharlesMangione@lemmy.world 11 points 1 week ago

"trust me bro"

[–] Maggoty@lemmy.world 9 points 1 week ago

Absolutely not. You can't just stop mental health treatment. It's like they stopped cancer treatment because the tumors started reacting to treatment. They aren't gone, the patient isn't in remission, they're going to die if they don't get more treatment.

[–] fishabel@discuss.online 27 points 1 week ago (1 children)

Guess they need a visit from our hero Luigi.

[–] JackbyDev@programming.dev 8 points 1 week ago

Assuming Luigi is guilty is stripping his rights.

[+] Encode1307@lemm.ee 13 points 1 week ago (2 children)

[deleted]

[–] Feelfold@lemm.ee 32 points 1 week ago (2 children)

Friend, I think you've drunk the Kool-aid.

The only reason the ADA can get away with recommending you brush your teeth 120 minues a month is, tooth brushes are cheep. The product don't cost insurance companies a dime. If tooth brushes cost $150 + an hour, you'd get 6 a year, so long as you'd met your deductible.

Mental health services are not just for folks who aren't doing well. Mental health services are prophylactic! To say that only folks not doing well need metal health services is medical model propaganda that the profit driven insurance industry wants you as a provider to buy into. They know they're screwing you over too! Remember when they made you sign a contract to not share your payout rates with other clinicians so you can't collectively bargain? The mental health parity act languished for ~ 16 years, and it's still a joke.

The term "Medical necessity" is corporate speak for "lower profits", and implies providers would be wide spread abusing the system if not for constant oversight. Meanwhile, they make billions on you, and your colleagues stolen labor.

[–] dragonfucker 7 points 1 week ago (1 children)

On the other hand, it's not like there are thousands of psychologists sitting around all day with nothing to do.

The best solution is to make it easier to become a mental health professional. More scholarships, more lower level training.

[–] Feelfold@lemm.ee 6 points 1 week ago

Before making it easier to become a mental health professional, we might think about retention. The APA figured a decade ago 65% of PhD (Psychology, not Psychiatry) students dropped out before program completion. The number that I've seen floated, but can't find a source other than from the UK is, 89% of mental health practitioners leave the field within two years of graduation. Poor pay, and insurance industry woes are almost aways cited as top reasons why.

[–] socphoenix@midwest.social 26 points 1 week ago (1 children)

The point of the article was about how the patients in question were only doing better(ish) due to intensive help from the therapists and still needed time.

From a lay persons view “better” does not equal doesn’t need continued therapy by a long shot and I’d rather have people use more therapy than they need than the other way around due to the outsize harms of getting that decision wrong.