60 Minutes covers the epidemic of medical necessity denials for mental health treatment

By Scott Glovsky on January 2nd, 2015 in Autism Insurance Coverage, Class Action, Insurance, Insurance and Healthcare Denials, Insurance Bad Faith

60 Minutes, a longstanding investigative news television program, recently aired a segment called “Denied” (S47, E13) in which it covered the health insurance industry’s practice of improperly denying coverage for mental health treatments on the ground that the treatments are not “medically necessary.” The news program outlined numerous stories that illustrate the cost in human life that results from the health insurance industry’s practice of restricting coverage for mental health treatment solely to save costs. Specifically, it shed light on stories of insureds living with mental illness, including bi-polar disorder, depression, and bulimia, whose illness was so severe that their very lives depended upon expensive and longstanding inpatient treatment.  The insurance companies denied coverage for the treatments that these people needed due to a purported lack of “medical necessity.”  In other words, the denials were on the ground that the insurance company did not believe that the services were necessary for the treatment of the mental illness. However, the show revealed, the insurance companies employ contract doctors who deny such coverage requests an overwhelming majority of the time. In particular, it found evidence of reviewers who denied 92%, 95%, and 100% of the claims that they reviewed despite only conducting minimal, if any, review and investigation into the claims. Health insurance companies favor denials of such mental health treatments as the denials save them substantial amounts of money–even though the money is saved at the expense of the insureds’ health, and in some cases, lives.

The 60 Minutes story highlighted the practices solely of Anthem Blue Cross and while we have brought numerous cases against Anthem Blue Cross for such improper medical necessity denials, we have seen and fought similar practices from numerous other insurers and managed health plan providers, including Kaiser and Blue Shield of California. For example, in Glick v. Anthem Blue Cross dba Blue Cross of California and Chase v. Anthem Blue Cross dba Blue Cross of California, we successfully represented children living with autism on behalf of themselves and thousands of other California children living with autism who were wrongly denied Applied Behavioral Analysis (“ABA”), a costly but extremely effective treatment for autism. In other past cases we successfully fought Magellan Health Services and United behavioral health for their improper denial of services to two young insureds who suffered terrible consequences due to their insurers’ decision to deny coverage for medically necessary treatment of their eating disorders. Recently, we have also filed suit on behalf of Charles Dion, a man living with obsessive compulsive disorder, and a class of potentially thousands of other Kaiser members in California who live with a severe mental illness, against Kaiser due to Kaiser’s failure to provide adequate psychotherapy (Dion v. Kaiser Foundation Health Plan, Inc.). These are just a few examples of the numerous cases we have brought to fight the insidious and industrywide practices discussed in the recent 60 Minutes episode.