You’ve gotten over some pretty big hurdles. You or your loved one has a diagnosis (no small feat quite often). Now there’s a recommended treatment plan. It’s been hard, confusing and very stressful. And probably took longer than you would have hoped. Whether dealing with physical or mental health issues, this is often the hardest part. But now there’s some clarity on actions to take and that can bring some relief.
And then, bam, everything comes to a standstill when you discover that either your insurance just plain doesn’t cover the treatment or somewhere in their process they have deemed the treatment “not medically necessary.” How in the world are you going to pay for this? It’s not bad enough you have to deal with the illness and treatment, but the finances add to the stress.
Of course, it sometimes happens that insurance companies deny claims for treatments for physical medical treatment, but this report by NAMI from April 2015, reports that mental healthcare claims are denied twice as often as physical healthcare claims. 60 Minutes did a segment in Dec 2014 and it has not gotten better since then.
I recently met a woman who did not take “no” for an answer when her insurance company denied her son the care he needed and was entitled to. Trudy is a strong and inspiring woman who took on the insurance company and won. You can read her full story here. Even more inspiring is how she now takes every opportunity to speak out and point out that “deemed medically necessary” is a catchphrase that allows insurance companies to avoid paying for pretty much anything. For any type of illness. Until we eliminate those terms, people are going to need to fight back like Trudy.
There are other people tilting at the windmills and winning. Another strong and persistent woman known as the “Insurance Warrior” spends her time helping others with all types of illnesses. It turns out that insurance companies expect that people will appeal claims that are denied, so if you’re not getting the coverage you need and are entitled to, file an appeal.
In addition, there is the Mental Health Parity Act of 2008 and you can learn more about parity - what it is, how your state is doing and what you can do to get help at ParityTrack.org. And of course, here at The Living Assistance Fund, we are bridging the gap to ensure you get the treatment you need.
So “be like Trudy”: take the fight to your insurance company, your state, speak out and up (stigma is our enemy in getting what we are entitled to) and support nonprofit organizations that help.