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A Oklahoma insurance company denied coverage to a mentally ill young woman. Kari Dove’s 19 year-old daughter was diagnosed with bipolar disorder in her mid teens. The disease is characterized with extreme mood shifts. As her daughter got older she began experimenting with drugs and alcohol, which led to her abusing the substance. This caused her to eventually develop psychosis, accompanied with delusions and hallucinations.
Blue Cross and Blue Shield of Oklahoma began denying claims a few month into her treatment. Letters from the company show that one of the claims denied was placement in a long-term mental health facility and substance abuse treatment center. The Doves have spent over $65,000 helping their daughter get the treatment she needs.
Due to Dove’s (her name has not been released) erratic behavior and refusal to get help, at the age of 18 her parents made her leave home. She lived on the streets and stayed in homeless shelters in Oklahoma. From April 2012 to August 2014 Dove was admitted to nine treatment facilities for residential treatment, detox, acute, and crisis according to her mother in a time line she prepared. Blue Cross has paid for only 58 days out of the 243 days she was in an in-patient facility. Three times the insurance company pre-approved what was sometimes weeks of treatment, that they would later deny once the claim had been submitted.
In 2014, the Doves daughter was admitted into a treatment facility in Sayre. She was suffering from seizures, and discussed ending her life. Dove and the facility had requested more time than the 21 days approved by the insurance company. The insurance company denied them more time, saying that the daughter had a supportive environment that was not dysfunctional to return to, despite the fact that according to her mother, she was homeless. The state of Oklahoma picked up the tab and she was able to remain in the facility for a few more weeks. A few days after she was released, her mother received a letter from Blue Cross denying the claim for all 21 day of pre-approved treatment, according to the letter it was not covered.
Dove filed a complaint with the Oklahoma Insurance Department, claiming that Blue Cross was not following parity laws. Soon after, with no explanation, Blue Cross paid for all 21 days of the pre-approved treatment.
Dove’s daughter a few weeks later tried to kill herself by taking pills. She received treatment for 11 days at the Norman Regional Behavior Center. Blue Cross paid for the treatment.
The Doves have said that if their daughter had needed to be placed in a facility to provide her in-patient treatment for a physical illness, that she would not have been denied. She went on to complain that she is only one person and that insurance companies bury people in paperwork, making it extremely difficult to get the care that is needed.
Oklahoma insurance companies denying medical care for the mentally ill should not be happening, especially with passage of the ACA. The ACA mandates that insurance companies must offer the same cost-sharing terms and treatment limit for the mentally ill, as they do for physical illnesses. Denying coverage is against federal and state law.
Advocates for the mentally ill, though, are saying that many times that mental-health parity is not occurring. Those with mental-health and substance abuse problems are not getting the treatment they need because of the parity not being followed. The National Alliance for Mental Illness’ chapter in Oklahoma has heard from many who have been denied treatment after the parity law went into effect, according to Executive Director, Traci Cook. She went on to say that if an insurance company denies paying for treatment, that sadly most people will not get the treatment.
In April, a survey conducted by NAMI found that 29 percent of respondents reported being denied coverage for mental health treatment, while only 14 percent had been denied treatment for other surgical and medical treatments. The mental health treatments were often denied for not being a medical necessity, even though the treatment was recommended by a clinician.
Insurance companies have offered less for coverage for mental health for decades. In order to prevent as many future denials for treatment for the mentally ill in Oklahoma and other states, NAMI is recommending that parity laws concerning mental health are enforced and that insurance companies be required to publish what kind of criteria they use to make their decisions.
By Jessica Hamel
Photo by Helga Weber-Creativecommons Flickr License