An insurance denial led my son to Florida, where he died from an overdose

The Parity Act prohibits discriminatory coverage of mental health and substance use disorder benefits, but it is not well enforced.

By Maureen O'Reilly

Within a week, Ed lost his job and broke up with his girlfriend. He was suffering from depression and his drug use escalated. He came home to live with us in New Jersey and we tried to give him support and encouragement, but after a couple of months, we could see he wasn’t getting better.

One night, we confronted him and Ed agreed to treatment. I immediately packed him a bag and brought Ed to a detox facility at 1:00 AM on a Sunday. He was using heroin and cocaine on a daily basis so I was sure that insurance would pay for treatment. But by Tuesday morning, the insurance company contacted the facility saying they wouldn’t cover inpatient detox. We moved him to another inpatient facility but again the insurance company refused to cover his stay.

When Ed was yanked out of treatment after a week, I was in a panic. I went online searching for facilities that might take him and accept his insurance. I found a place in Florida, not knowing about the many scams with patient brokering. I called them and they said they’d work with insurance. We put him on a plane down to Florida the next day. We thought he’d be inpatient for 30 days and then recover. We were so naïve about it.

Ed cycled between treatment programs and sober houses. And the insurance denials continued. I could see the treatment program was having a tremendous struggle with his insurance, which was paying them practically nothing. I think the facility was frustrated with getting nothing from insurance, and in turn became frustrated with Ed. The discharge notes said that “Ed was getting entitled.” He was discharged with no plan. Nothing. Ed died from an overdose in a sober home shortly after.

After Ed’s death, I sued the health plan and was able to get internal records showing that a week after he was removed from the inpatient facility in New Jersey, an internal review found that his stay should have been covered. I was never notified.

“The denial letters stated: ‘you have sober parents; you can go home and live with your parents; you’re motivated to get better.’ He was desperate to get better but he needed help.”

The Problem

The Mental Health Parity and Addiction Equity Act (Parity Act) requires most health plans to cover mental health and substance use disorder treatment the same way they cover treatment for any other disease. Despite strong legal protections, millions of families still struggle to get insurance coverage for addiction treatment and are unaware of their rights to affordable care due to weak enforcement and poor implementation of the law.

Enforcement of the Parity Act relies on consumers to file complaints identifying violations. This an undue burden on consumers, who are largely unaware of the law and unlikely to navigate a burdensome and consuming complaints process in the middle of a crisis.

The Parity Act also has no teeth. The Department of Labor, the federal agency responsible for parity enforcement, lacks authority to levy civil monetary penalties for violations.

The Solution

Improve enforcement of the Parity Act by shifting enforcement off consumers and onto regulators to ensure plans do not offer discriminatory coverage before they are sold to consumers. Provide federal and state insurance regulators with additional tools to enforce the Parity Act.

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