Providers, patients and even some federal judges say progress-based insurance denials harm patients at key moments of mental health treatment.

Providers, patients and even some federal judges say progress-based insurance denials harm patients at key moments of mental health treatment.

  • Australis13@fedia.io
    87·
    3 days ago

    Honestly, I have to wonder if the cruelty is the point here. Even in the cold light of pure financial terms, it’s bad for insurers to behave this like:

    Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.

    During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.

    A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.

    • varyingExpertise@feddit.orgEnglish
      8·
      2 days ago

      Likely some internal incentive program that rewards certain minimum rejection rates. Costs following that are counted elsewhere.

      • irotsoma@lemmy.worldEnglish
        17·
        2 days ago

        Same thing that most people say about antibiotics. I don’t need to finish this, I’m getting better now, and then they relapse and the antibiotics don’t work the second time around. Stopping the treatment of a disease when the patient just begins recovery rather than allowing the patient to fully recover is always bad and sometimes means the second try will be that much more difficult as they are traumatized by the poor result of the previous try. “Fine” is not recovered. I was “fine” for 40+ years with undiagnosed ASD and ADHD, because I learned to mask so I appeared “fine”. But really I just had to end treatment every time before prior to finding the root causes.

          • bane_killgrind@slrpnk.netEnglish
            11·
            2 days ago

            They aren’t doctors, or they aren’t the patient’s doctor. They sometimes don’t even have a specialization in the treatment they deny coverage for.

            Completely unqualified.

            • Apytele@sh.itjust.works
              6·
              2 days ago

              He’s right that there’s a therapist shortage but

              a) that’s because it’s a low-to-medium-wage job where people just trauma dump the worst moments of their lives on you for an hour. Insurance does NOT like paying out for hours of human labor from anyone including nurses (my field) but at least with me each patient is only getting fractional hours, usually about a sixth or less of each hour billed depending on my assignment for the night. So my pay rate is somewhat similar, but it’s for six patients at a time. That therapist is billing for a full hour per patient. The health insurance is gonna haggle pretty aggressively over that rate.

              b) it’s also a symptom of the widespread destruction of natural social support systems in favor of commoditized human interaction. A lot of long term therapy users probably wouldn’t need therapy long term if we were properly maintaining and hosting social spaces and events. There’s been a lot said about the steady dismantling of free “thirdspaces” or spaces that aren’t your work or home that you can go to purely to socialize / mingle with other people. There are still a few libraries and parks but even those are getting funding cuts. If the rich hadn’t figured out how to bill us for the bread and circuses, a lot of people would be more mentally and socially healthy to begin with and wouldn’t have to pay for social interaction.

              Neither of those problems is best solved by dumping people out of therapy, the root causes need to be addressed first.

              • Maggoty@lemmy.world
                2·
                2 days ago

                Oh that I agree with. It’s the whole, “most people don’t improve after 16 sessions” bit they had going. A lot of people out there require years of work to become functional again and the last thing they want to hear is that they’re a lost cause because they weren’t functional after a few months of therapy. Especially because it’s not true and because there’re far better ways to move someone into an outpatient/maintenance treatment plan than, “we yanked your funding because we think you’re actually okay now.” As the article explains, that kind of rug pull causes serious mental distress. It would cause anyone mental distress to have a support yanked out from under them, but people who are already struggling will obviously have worse outcomes.

          • irotsoma@lemmy.worldEnglish
            7·
            2 days ago

            Only the criteria here was, “You have made progress.” And “You are not a danger to yourself or others.”. There is no condition about having to be at a point where you are no longer making progress, only that the person is no longer suicidal/homicidal at the current stage of progress. This isn’t at all saying the patient wouldn’t benefit from further therapy. That’s not a condition for the “medical necessity” in this case. If your only criteria is that the person is somewhat improved and not in an emergency situation, then there is a high likelihood of regression upon cessation of medical intervention in any field of medicine. Hoping that they’ll be able to get help again before they become suicidal/homicidal again is not a strategy and usually ends in tragedy. Most times they don’t even bother to seek help. This case the person went to the ER, but often that’s not going to happen if the person considers the cost of the Ambulance, ER, and hospitalization on top of the mental energy required to make the call and then explain your whole history to someone new and then justify your need for the services. It’s unreasonable to expect a good outcome the more times the person has a bad outcome.

      • Maggoty@lemmy.world
        9·
        2 days ago

        Absolutely not. You can’t just stop mental health treatment. It’s like they stopped cancer treatment because the tumors started reacting to treatment. They aren’t gone, the patient isn’t in remission, they’re going to die if they don’t get more treatment.

    • Feelfold@lemm.ee
      372·
      3 days ago

      Friend, I think you’ve drunk the Kool-aid.

      The only reason the ADA can get away with recommending you brush your teeth 120 minues a month is, tooth brushes are cheep. The product don’t cost insurance companies a dime. If tooth brushes cost $150 + an hour, you’d get 6 a year, so long as you’d met your deductible.

      Mental health services are not just for folks who aren’t doing well. Mental health services are prophylactic! To say that only folks not doing well need metal health services is medical model propaganda that the profit driven insurance industry wants you as a provider to buy into. They know they’re screwing you over too! Remember when they made you sign a contract to not share your payout rates with other clinicians so you can’t collectively bargain? The mental health parity act languished for ~ 16 years, and it’s still a joke.

      The term “Medical necessity” is corporate speak for “lower profits”, and implies providers would be wide spread abusing the system if not for constant oversight. Meanwhile, they make billions on you, and your colleagues stolen labor.

      • Dragon Rider (drag)@lemmy.nzEnglish
        92·
        3 days ago

        On the other hand, it’s not like there are thousands of psychologists sitting around all day with nothing to do.

        The best solution is to make it easier to become a mental health professional. More scholarships, more lower level training.

        • Feelfold@lemm.ee
          6·
          2 days ago

          Before making it easier to become a mental health professional, we might think about retention. The APA figured a decade ago 65% of PhD (Psychology, not Psychiatry) students dropped out before program completion. The number that I’ve seen floated, but can’t find a source other than from the UK is, 89% of mental health practitioners leave the field within two years of graduation. Poor pay, and insurance industry woes are almost aways cited as top reasons why.

        • AnIndefiniteArticle@sh.itjust.works
          16·
          3 days ago

          Should they pay for high quality childcare, housing and healthy food too?

          Yes.

          Remove the for profit “health” insurance companies and provide people with these things. It will reduce our societal costs and improve outcomes for all.

        • Senal@programming.devEnglish
          6·
          2 days ago

          They should pay for prophylactic counseling?

          Yes, because prevention is superior to treatment after the fact in both outcomes & overall cost.

          Though it seems you have a differing understanding of “Medically Necessary” to my own so i suspect we won’t agree on this.

          “For profit healthcare” is a misnomer is should be called something like “profit equilibrium maintenance : healthcare edition”

          The best outcome for a “for profit” is profit, not healthcare. Given the choice between larger profits and better healthcare outcomes the profit will win out, every time.

        • Assian_Candor [comrade/them]@hexbear.netEnglish
          8·
          2 days ago

          How is paying for prophylactic counseling any different than paying for routine checkups?

          Like surely you have patients who need meds or their lives fall apart but are otherwise doing just fine? Quick check in once a month and everyone goes on their merry way?

          Why should somebody’s access to care be compromised because they are feeling better? This isn’t bronchitis these are lifelong conditions

    • socphoenix@midwest.social
      321·
      3 days ago

      The point of the article was about how the patients in question were only doing better(ish) due to intensive help from the therapists and still needed time.

      From a lay persons view “better” does not equal doesn’t need continued therapy by a long shot and I’d rather have people use more therapy than they need than the other way around due to the outsize harms of getting that decision wrong.