How much more evidence do we need?
You don’t have to go far to find examples of health insurance companies denying coverage or making it exceedingly difficult to access in-network care. Maybe you’ve even experienced it yourself.
This is particularly true when it comes to mental healthcare, even amid our current climate, where mental illness, substance use, and suicide rates are on the rise. All despite the fact that insurers are required to cover mental health conditions on par with coverage for physical conditions – a regulation that unfortunately doesn’t appear to have any teeth.
A recent article in The Washington Post chronicles the journey of 21-year-old Max Tillitt, who became addicted to prescription opioids following a high school football injury. Tillitt struggled with other mental health conditions and relapsed between seven and eight times over several years.
But, according to the Post, he “was finally making progress in his battle with addiction and mental illness when word arrived that United Behavioral Health was cutting off his benefits.”
Though Tillitt needed 45 days at Beauterre Recovery Institute in Owatonna, Minnesota, United would only cover 21 days. Discharged 24 days too early, he went home and, two months later, died of an overdose.
Tillitt’s story is not uncommon. And it speaks to an ugly truth about our country’s healthcare system: Insurers—and their unequal coverage of physical and mental health conditions—are one of the major reasons the United States is continues to experience a mental health crisis.
The article states: “Consumers seeking psychotherapy and drug treatment contend with administrative roadblocks, network shortfalls and more-restrictive benefits than they receive in coverage for physical health, according to advocates, public officials and a host of analyses, court cases and government reports.”
Of course, the health insurance industry accepts no blame and takes no responsibility. Rather, insurance companies continue to fault a lack of providers. And sure, it’s easy to call a system ‘broken’ when you’re the one holding the hammer.
But how can insurers expect clinicians to keep seeing patients when they’re continually being shortchanged? Left with limited options and low reimbursement rates from payors, many providers elect to see patients privately, and avoid insurance altogether.
What’s worse—as we regularly point out—is that companies like United aren’t being held accountable for their actions. According to the Post, The Labor Department has sued a big insurer only once, despite the myriad examples of payors failing to adhere to federal coverage laws.
So, you might think your employer’s plan is just particularly bare bones. You might think you live in an area where there simply aren’t enough psychiatrists. And these things may be true. But from coast to coast, across big cities and in small towns, people are struggling to access care because insurers aren’t following the law.
When are we going to sufficiently fine carriers so that they start covering the lifesaving care its members pay for and are legally obligated to receive? Because the ultimate cost of denying mental and behavioral health coverage is human lives.
And so far, it seems that’s a price that United is willing for us to pay.