I Was Blindsided By How Insurance Treated My Son’s Substance Use Claim

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The day my 17-year-old son entered residential treatment for substance use disorder was a time of huge relief for me. We had been in crisis mode for some time, and I had been hoping and praying that we could get him into treatment before tragedy struck. After finally getting my son into residential treatment last fall, my husband and I exchanged a smile with him as we left to return home. We were full of hope for the future.

We were also ready to return to some normalcy. With my son safe in a treatment facility, I was ready to return my focus to my career as an insurance lawyer, my other family members, and my self-care. Things were great for two days — until I was blindsided by my health insurance company.

Before my son entered residential treatment, I did my homework. I read my insurance plan’s explanation of benefits booklet to see if it provided coverage for treatment of substance use disorder. I was pleased to find that it did! In fact, there was only one sentence devoted to coverage for substance use disorder, in contrast to the numerous pages devoted to coverage for medical and surgical services. So, I figured it was not a complex issue. I turned out to be horribly wrong. Two days after my son was admitted into treatment, the director of the treatment facility called me to tell me the insurance company was denying coverage.

To say I was shocked is an understatement. The treatment facility told me I had limited options, all of which required me to pay thousands of dollars out of pocket in order to keep my son in treatment. I had to scramble and pull from many resources to keep him in treatment.

"I was stuck in the middle of an untenable catch-22 between the treatment facility and the insurance company, while my son was fighting for his life and my family was in crisis."

Virginia Holleman

Even though I practice insurance coverage law and am an informed consumer, I was not clear on my rights under the federal law and how it governed my particular insurance plan. But I soon learned that claims for treatment of mental health and substance use disorders are not paid equitably as other health claims are paid, despite federal law that requires otherwise.

A recent survey found families don’t speak up when they are denied care and are less likely to challenge denials of mental health or substance use disorder benefits than denials for medical care.

While substance use disorder does not discriminate with regard to who is susceptible to the disorder, recovery does discriminate. The disparate treatment by health insurance companies of substance use disorder treatment claims is just one way in which people are denied the opportunity to get well and recover.

I dug in, researched and tried to learn as much as I possibly could. The Kennedy Forum was extremely helpful in navigating me through all the many issues and in helping me decide what action I needed to take. To begin, I registered a Parity Act complaint in an effort to help end such discrimination. To help my own cause, I spoke with the insurance company care coordinator assigned to my son’s claim; I filed multiple appeals; and I filed a complaint with my state insurance commissioner. Each one of these actions helped to move things forward, but my family was still in crisis.

I am still battling the insurance company on issues that remain, but I have learned a lot in the past year. I think the biggest lesson I have learned from all of this is that I am my son’s best advocate. I had to fight for his life. I had to fight to get him into treatment. Then I had to fight to keep him in treatment. I had to fight the insurance company. The fight continues. I will keep on fighting.

Help fight for your family and for families like mine. This month is the 11th anniversary of the enactment of the Mental Health Parity and Addiction Equity Act, yet insurance companies continue to evade the law and deny treatment. Write to your Members of Congress today to pass the Mental Health Parity Compliance Act to strengthen enforcement and help provide coverage for millions of Americans struggling with substance use disorder.

Help Pass the Mental Health Parity Compliance Act

Ask your Members of Congress to pass the Mental Health Parity Compliance Act to strengthen enforcement and help provide coverage for millions of Americans struggling with substance use disorder.

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    Rose Gomez M.D.

    December 2, 2019 at 3:37 PM

    This is so true and unfortunately most families find out the way you did. Keep fighting!

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    Suzanne Geimer RN, BSN, CEN

    October 30, 2019 at 1:12 PM

    As an RN with over 30 years’ experience working with people experiencing addiction problems, I can say with certainty that this is a problem needing a better approach and education regarding the importance of long term therapy and support. Emergency rooms are increasingly overwhelmed with frequent returns of those experiencing addiction problems. They are treated and released with no feasible plan for follow up or placement.

    The problem continues and we see them again and again, frequently in a worsening state. With help from the addition of case managers and social workers, some patients can be placed short term but need help for follow up.

    Anxious parents, seeking help for teens need support and education in along with the young person needing help. This is not a quick fix problem and insurance companies need to get on board with a total overhaul of the approach to this problem. If not now… the problem gets bigger and more expense involved caring for increased and additional medical problems due to addiction. It is in the interest of all involved to create a better plan with realistic coverage to help treat and change lives for the better.

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    Rob Fleming

    October 30, 2019 at 12:28 PM

    They say “all politics is local”, and an appeal to any member of Congress will have more impact if there is a local “hook”. Before you write to Congress, take a look at https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables , which are the latest (collected 2018) statistics on Drug Use and Health. State-level stats are good for writing Senators, but you may have to dig a little to find out what Substate Area you, and your Congressman, are in. Chances are, he or she represents more than one Substate (County, Ward, Parish, health district, etc.), so you can get statistics for your neighbors, too.

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