- Dec 15, 2014
- by The Kennedy Forum
Statement of Patrick J. Kennedy on “Denied”
My heart goes out to the people whose tragic stories of denied care were outlined on 60 Minutes last evening. Sadly, I have been hearing similar stories of people with mental illnesses or drug and alcohol problems being denied insurance coverage for more than 20 years. It was one of the reasons I made mental health parity my primary focus while in Congress, and why I started The Kennedy Forum in 2013. I want to see these issues, which affect so many of our friends and family members, become a thing of the past.
It’s also why I sponsored the Mental Health Parity and Addiction Equity Act – the law prohibiting discrimination in insurance coverage – in 2008. This bipartisan legislation, signed into law by President George W. Bush, was, in part, intended to ensure that no individual, no family – no American – had to endure what we saw outlined on 60 Minutes.
The federal law prohibits insurers from using a more restrictive review process for mental health care than for medical and surgical care. I don’t believe patients with life threatening diabetes and heart disease would be forced out of treatment in this way! Are denials of care as prevalent in general medical settings as they apparently are in mental health care?
At best, we’re seeing inconsistent compliance with the law. The pattern of denials detailed in the 60 Minutes report is not confined to one company. We see major problems at all levels of service: from stabilizing someone in crisis, to a lack of access to lifesaving residential programs, to giving patients access to the newest and most promising treatments (which are routinely covered in other areas of health care).
There have been at least 10 lawsuits filed over violations of state and federal parity law in the last 3 years alone. Fines have been assessed by state regulators, as well. On Monday in New York, a federal court is deciding if a patient has the right to sue his insurer for denying care and violating the federal parity law. The allegations in this case are similar to those raised in the 60 Minutes story. People with very serious mental and substance use problems are having claims denied at apparently high rates by the two largest health insurance companies in the US – companies providing mental health benefits to millions of citizens.
Can you imagine if there was another law on the books so routinely misused, ignored, and disregarded? There would be an outcry.
Here’s what needs to happen:
We need to learn how insurers make their coverage decisions and whether mental health is on par with physical health in the application of “medical necessity” criteria. From the information we have seen thus far, we can only assume that the standards used for behavioral health are more stringent and thus illegal.
State insurance commissioners must investigate the conduct of these insurers, to ensure their “medical necessity” determinations stand up to the parity test.
And, most important, the federal government needs to do two things required of them:
1. Provide additional guidance on insurance company disclosures and transparency. We call on them to do it within 60 days, or risk seeing more stories of care denied, families shattered, and lives lost.
2. Bring its own programs into compliance with the parity law. We need to know how this applies to Medicaid, for example, a program that covers 65 million Americans.
This is why I created The Kennedy Forum: To advocate for the full and unequivocal implementation of the parity law, which we see as the gateway to a better approach to mental health service delivery in America. To send a message that access to mental health is a right. To lead a national discussion, and be an impartial convener advancing best practices. And to establish clear, widely accepted guidelines and tools for this law’s implementation. We look forward to working with leaders from every sector to advance these goals.
In the New Year, we will be providing tools for individuals needing care for their mental health or substance use conditions as well as for employers and other payers. These tools will help patients, providers, payers, and regulators to understand their rights and responsibilities under the parity law. Annually, our nation’s failure to treat mental health and substance use disorders costs employers an estimated $80 to 100 billion. Nothing will move our culture to true parity faster than market demand for the rights already guaranteed under law.
At the end of the day, we want to see fairness for patients who are seeking mental health services, and a health care system that’s complying with the law…so we don’t have to see another segment on 60 Minutes documenting how denied care meant a life lost or a family shattered.