Even though federal and state laws require that insurers cover mental health issues, far too many people experience frustration regarding the uphill battle they face when attempting to get their insurance company to pay for these treatments. There may be overly restrictive rules about whether the treatment is “medically necessary,” as well as long waiting periods to get necessary mental health treatments. In today’s world, mental health treatments are more crucial than ever, yet many insurers are becoming more “creative” in avoiding payment for these treatments.
If you or a loved one are facing an insurance denial for mental disorders, it’s important that you not give up without a fight. It is equally important that you have a strong advocate in your corner who will fight on your behalf, helping to appeal a denial and insisting that you receive a full, fair review. Mental health is every bit as important as physical health and having a strong, experienced attorney from the Law Offices of Scott Glovsky by your side can turn a denial into an approval.
Why Claims Associated with Mental Disorders May Be Denied
Although your insurer is unlikely to ever state that a medical treatment is being denied because it costs too much, in reality, this is the most common reason treatments are denied. Insurance companies are often much more interested in their financial bottom line than in the lives of those who purchase their insurance. The explanation you receive for an insurance denial of treatment relating to mental disorders may come in the form of “not medically necessary,” “experimental,” or “investigational.”
Your claim could also have been denied because it lacked information, you failed to obtain necessary prior authorization, or the treatment is specifically excluded from your healthcare plan. Many issues can be fairly easily corrected, however, if your insurer is denying your claim because it feels it is not medically necessary or is experimental or investigational, you should speak to attorney Scott Glovsky.
What Can You Do About an Insurance Denial for Treatment of Mental Disorders?
If you are feeling hopeless following an insurance denial related to the treatment of mental disorders, you should know that this is by design. Your insurer is counting on the fact that you won’t fight back because it benefits financially by denying claims. In fact, according to the New York Times, of the 1.4 billion claims filed under employer-based health plans, 100 million of those are initially denied—one out of every 14 claims.
Yet when people fight these denials, they often win—as much as 50 percent of the time. You can start with an internal appeal where you ask your insurer to reconsider its initial denial. A letter from your doctor explaining the necessity of the treatment may help you get the denial reversed. If this internal appeal is unsuccessful, you can file an external appeal with a neutral third party. It can be daunting to try and file these appeals on your own. A knowledgeable insurance denial attorney from the Law Offices of Scott Glovsky can help give your appeal a much better chance of success. In addition, he may suggest taking legal action instead of filing an external appeal.
Specific Insurance Companies That Are Known to Deny Mental Disorder Treatments
United Behavioral Health—a subsidiary of UnitedHealthcare—was sued for relying on overly restrictive internal guidelines that were inconsistent with generally accepted standards of care. United was found to be paying only for short-term treatments for clients that required more comprehensive treatments, essentially getting them through the acute phase, then approving only significantly reduced levels of mental healthcare.
It is well known that insurers generally pay in-network behavioral health providers far less when compared to medical and surgical providers, resulting in an inadequate network of providers. The ultimate result of this is that patients cannot find in-network providers so they are forced to pay much more for an out-of-network provider. While any health insurance company may issue an insurance denial for treatment of mental disorders, some are more likely than others to do so, including:
Common Treatments and Drugs Prescribed for Mental Disorders
Some of the most commonly prescribed drugs for mental disorders include:
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa, Lexapro, Prozac, Luvox, Paxil, and Zoloft
- Anti-anxiety medications like Xanax, Klonopin, Librium, Ativan, and Valium
- Mood-stabilizing medications like Lithium, Tegretol, Depakote, Haldol, Zyprexa, Seroquel, and Risperdal
- Antipsychotic medications like Olanzapine, Latuda, and Vraylar
Other treatments for mental health disorders include:
- Psychotherapy with a trained mental health professional
- Support groups
- Alternative treatments
- Peer support
How a Mental Disorder Insurance Denial Can Affect Your Life
Some of the more commonly diagnosed mental disorders include:
- Bipolar disorder
- Eating disorders
- Obsessive-compulsive disorder
- Oppositional-Defiant Disorder
- Alcoholism or Alcohol Use Disorder
- Gender dysphoria
- Drug dependency
You may need inpatient therapy, outpatient therapy, partial hospitalization, or residential treatment along with a specific drug for your mental disorder. If you have been prescribed a drug or treatment for your mental disorder only to have your insurance company deny payment, you may be feeling frustrated and overwhelmed. Living with a mental disorder affects every aspect of your life. When a treatment that your doctor believes will significantly help you is denied, you may not know where to turn or what to do. Most of us have very busy lives, meaning that finding the time to get everything together for an appeal can seem like too much. Having a highly skilled advocate from the Law Offices of Scott Glovsky can help ensure that you get the treatments you need for your mental disorder.
How the Law Offices of Scott Glovsky Can Help with an Insurance Denial for Treatment of Mental Disorders
When you choose the Law Offices of Scott Glovsky, you are getting an experienced legal team with the mission of helping those who have been wronged. We will listen to you, support you during a difficult time, are available and responsive, and always place your needs first. Attorney Scott Glovsky will treat you with dignity and respect as he aggressively fights for your health and your future. At the Law Offices of Scott Glovsky, we only take cases we believe in—and those that expose wrongdoing on the part of a big insurance company. In the end, if results matter, contact the Law Offices of Scott Glovsky.