Attorney for Depression Treatment Denials
Depression is a serious medical condition that can affect every aspect of an individual’s life. Depression can result in loss of energy, difficulty concentrating, loss of enjoyment and pleasure, anxiety, melancholy, and suicidal thoughts. According to hopefordepression.org, depression is the most prevalent mind-brain illness, affecting more than 18 million adults in any given year. In fact, according to a February 2023 Gallup poll, 29% of American adults have been diagnosed with depression at some time in their life. Depression is the leading cause of disability for those between the ages of 15 and 44 and is the primary reason a person dies of suicide every 12 minutes in the U.S.
Treatment for depression can be denied by health insurance companies for a variety of reasons, using sometimes questionable methods to determine whether a specific depression treatment is medically necessary or is covered under your policy. If you are entitled to receive depression treatment, you can appeal an adverse decision by your insurer. An appeal is the best way to ensure you receive necessary medications or other treatments following a depression treatment denied by insurance. Don’t face such a situation on your own—Attorney Scott Glovsky and his legal team are waiting to help you get the depression treatments you need.
Why Could Your Depression Treatment Be Denied by Insurance?
Depression treatment denied by insurance can be frustrating and confusing. Treatments may be denied for a relatively simple matter such as an omission or mistake on a form or could be denied due to lack of prior authorization, or because the treatment is out of network or not covered under your policy. Your insurance company may require you to try step therapy, which means you must try one or more less-expensive drug therapies before your insurer will pay for the medication prescribed by your doctor. This can be a time-consuming process, as you will have to report that the less expensive drug did not work to your doctor after trying it for a month or more.
A depression drug or treatment may be denied because your insurer finds it to be “not medically necessary, experimental, or investigational”. If you believe the depression drug or treatment is not approved because your depression is not considered equal to other health conditions, you may have a case under federal and state mental health parity laws. These mental health parity laws, however, may be ignored by your insurer if they think nobody will call them on the practice. If you have to call and obtain permission to get mental health care covered, but you don’t for other types of care, you may have a valid claim.
Further, if a depression treatment was denied under the guise of being “not medically necessary,” but your insurer cannot provide the specific criteria they used for the determination, you may be able to appeal the decision. If your insurer is claiming the treatment or drug is not medically necessary or experimental, you will need to rely on your doctor to provide supporting information showing the treatment is medically necessary, and that the drug is no longer considered experimental.
What Should You Do About Depression Treatment Denied by Insurance?
If you are experiencing depression treatment denied by insurance, you need experienced, knowledgeable assistance, and you need it quickly. At the Law Offices of Scott Glovsky, we will help you file your internal appeal, which essentially asks your insurer to reconsider its decision. If you still receive a denial for a treatment you need to manage your depression, you can file an external appeal with a third party. The decision of this third party is binding. And that’s why it is a good idea to speak with an experienced health insurance attorney before you file. The most commonly denied depression treatments include residential treatment for depression, intensive outpatient treatment, partial hospitalization, psychological rehabilitation, and some of the more expensive pharmaceuticals developed for depression.
Which Insurers Are Most Likely to Deny Your Depression Treatment?
The parents of a teen who had attempted suicide at least half a dozen times before an appropriate residential care facility was found were then forced to deal with their insurer’s refusal to pay. Denial of health insurance coverage for depression treatments continues to be common, despite federal and state parity laws. DBT, a structured form of treatment that includes individual, group, and family therapy, was the treatment the insurance company denied, claiming it was experimental.
The denial came in the face of a 2018 clinical trial showing that a six-month outpatient DBT treatment is more effective for teens than any other general therapeutic approach. While Medical Mutual happened to be the insurer denying this particular claim, virtually any healthcare provider can be responsible for a depression treatment denied by insurance. California insurers who may deny a legitimate claim for a depression treatment include UnitedHealthcare, Anthem Blue Cross, Blue Shield, HealthNet, Kaiser, or Aetna, along with others.
Which Depression Treatments Might Your Doctor Prescribe?
While there are few new medications for depression, on March 5, 2019, the FDA approved a nasal spray called Esketamine—an anesthetic derived from ketamine that has a surprising antidepressant effect. In one study, patients diagnosed with treatment-resistant depression received an oral antidepressant and either Esketamine or a placebo. More than 70 percent of those who received esketamine improved, as compared to less than 50 percent who received a placebo in place of esketamine. Esketamine can cost from $7,000 to $11,000 for the first two months of treatment. Other common depression treatments include:
- CBT (Cognitive Behavioral Therapy)
- DBT (Dialectical Behavior Therapy)
- Inpatient treatment
- Analytical psychotherapy
- Systemic therapy
- Antidepression medications (usually used in conjunction with psychological treatment) like Celexa, Lexapro, Prozac, Paxil, Zoloft, Cymbalta, or Seroquel. These drugs can be expensive—from $300 to $3,000 per month.
- TMS therapy
For very serious depression, a provider might recommend a more intense mental health program such as an intensive outpatient program, a partial hospitalization program, or a residential treatment center program.
The cost of many depression treatments can be high—making it more likely those treatments will be denied by your insurance company. Your insurer may claim the treatment is not medically necessary, or that it is experimental or investigational.
Where to Turn After a Depression Treatment Denied by Insurance
So what should you do following a depression treatment denied by insurance? If your insurer is requiring step therapy, you will have to try prescription drugs that are cheaper than the one your doctor has prescribed. Once you try the less expensive drug and find it does not work, you will be moved to the next less expensive drug, until you can take the drug actually prescribed. Whether the depression treatment is for you or for a loved one, it can be incredibly frustrating to be unable to access the treatment your doctor believes will help you the most simply because of your insurance company’s refusal to pay.
This is a time in your life when you need a compassionate advocate who will fight for you, for your rights, and for your future. That advocate is attorney Scott Glovsky. Scott will help you achieve the peace of mind you deserve, knowing that the health insurance company you have faithfully paid will fulfill its obligations to you. Insurance companies are primarily interested in their financial bottom line, so they often must be forced to do the right thing in the face of deny, delay, and underpay tactics. Scott Glovsky has made it his job to ensure his clients are never taken advantage of or forced to deal with an act of bad faith on the part of an insurer.
Getting the Help You Need from the Law Offices of Scott Glovsky
Attorney Scott Glovsky and his legal team will force your insurance company to fulfill the promises they made to you in return for your monthly premiums. Scott understands that a depression treatment denied by insurance can feel overwhelming. A lack of medical necessity denial can be used by insurers to minimize costs—even at the expense of your health and best interests. Your health insurer may have denied your claim on the grounds that it is experimental or investigational. The Law Offices of Scott Glovsky has helped many people do what is required to turn a denial into an approval. Contact the Law Offices of Scott Glovsky today for the assistance you need.