Loopholes Depart Gaps in Mandated Protection for Psychological Well being


“That was a real surprise,” said the father, who only wanted to be identified by his middle name, Paul, in order to protect his family’s privacy. “They had never seen that before.”

West Virginia lawmakers have since passed laws providing equal treatment for mental illness and substance abuse, though the doctor’s plan was still exempt on the latest government lists. State plan officials did not respond to requests for comment.

Even relatively inexpensive treatment can be hard to come by. In Chicago, Julia, a former patient of Dr. Michael, whose husband worked for the town and asked not to be identified by her last name in order to protect her family’s privacy, the cover in recent years to treat her anxiety.

Unlike her previous policy with a different Blue Cross plan, a new one that was overseen by an outside company required cumbersome pre-approval for therapy, she said. She had to provide detailed information that she had previously received from her therapist, including the exact diagnosis code and the so-called NPI number to identify the provider. The company started allowing fewer visits at a time, she said.

“It just forces you to jump through the hoops, call back and keep track,” she said. If you missed an authorization, you will have to pay the full cost of the session.

She also said she had been pressured to estimate the duration of treatment or to finish treatment, a schedule that stands in stark contrast to any questions about her other illnesses. “I don’t have to pre-approve my dermatology appointments,” she said. “Rosea never goes away. Nobody asks my dermatologist to cure rosea. “

She stopped therapy when she felt she could handle her condition appropriately.

Lawyers and patients say enforcement of the law has often been lax and that many insurers and employers refuse to pay for expensive mental illness treatments. But the involvement of both state and federal regulators in the $ 14 million settlement with United “is very significant,” said D. Brian Hufford, an attorney at Zuckerman Spaeder, whose law firm has represented individuals in the private claims. His law firm also represented plaintiffs in another lawsuit against United that resulted in a 2019 ruling against the company in which a federal judge in Northern California said one of its units had established internal policies aimed at effectively discriminating against patients , to save money. United said its customer care was appropriate and the case is now under appeal.