By: Tessa May
Caren and Bob Smith’s* daughter, Ellie, is getting treatment at a long term hospital in Utah, to get the best care possible for her condition. They are living in a situation where they can’t pay for the treatment because the insurance companies are refusing to take care of their overpriced medical bills.
In the middle of 2019, Ellie was placed in a residential treatment center for severe depression. The reason that this treatment center was chosen was because it had a community living based environment. These types of treatment centers are made to be as similar as home as possible, so that when the patient is able to go home they are used to it. Although she is not living at home or with her family, Ellie is still in an environment with other highschoolers that attend school as well as multiple therapy sessions each day.
Depression and other mental illnesses are a common issue in many teenagers, although many people prefer not to talk about it, because it can feel like you are in the wrong for having one, they may also be scared of being judged because of this. This is because for some people if they don’t know much about mental illness they might think that it is a mood or simple feeling that could go away by doing something fun. They might also think that if you have a mental illness you are a crazy person that will never get better, and that you need to be locked up in an institution. In reality, having a mental illness, similar to having a physical illness could be very different from each other, in the sense that there are different types that can be treated in many different ways and some can be treated more easily or in more difficult ways than others. Over the years mental illness has become something that people have started to treat in many different ways, for example medication and therapeutic treatment. In severe cases like Ellie’s, the only effective treatment is placing the patient to a residential treatment center where they can be protected and get the highest level of care. Like many other treatment approaches, without the help of insurance, treatment is unaffordable for anyone except for the most wealthy people. Depending on the treatment center, and the length in which the patient attends the center, the cost can be between $10,000 to $20,000 per month, wich ads up to being more than many peoples yearly salary.
“It feels completely unfair,” Bob explained, “we’ve been paying our insurance bill for years, and when we finally need it, they aren’t there for us. It puts a ton of stress on us.”
According to the American Psychological Association, the federal law says that insurance companies need to pay for medically necessary treatment. This means that they need to cover mental health at least equally to medical and surgical coverage. This law also says that you need to prove that the patient needs the help and that they are in the best place for their cause. In many cases with people in residential treatment centers for mental health, the insurance companies deny the most sound claims. This happens in many cases because the companies do not believe that residential treatment centers for mental health need as much time or care as physical health, effecting in them not wanting to spend a large amount of money on it.
In one of the emails to Bob and Caren from the insurance company says,
“Benefit coverage of residential level of care is not available on 07/31/2019 and forward. This is based on UBH Level Of Care Guideline for Mental Health residential level of care and the UBH Common Criteria and Clinical Best Practices for All Levels of Care Guidelines. Your child is in treatment for chronic depression. She has been in residential level of care since July 1, 2019. At this time, it appears that she can be treated in a partial hospitalization program near your home. The American Academy of Child and Adolescent Psychiatry (AACAP) article entitled, “Principles of Care for Treatment of Children and Adolescents with Mental Illness in Residential Treatment Centers,” describes the industry standards (that is the generally accepted practices) for this level of care. The introduction to the article begins with “The best place for children and adolescents is at home with their families. A child or adolescent with mental illness should be treated in the safest and least restrictive environment and needed services should be ‘wrapped-around’ to provide more intensive home or community-based services. . .”
This article explains how, because the article is saying that Ellie is better off at home rather than at a residential treatment center, that the best place is always at home.
In an email in response Bob shows what the first sentence of the article actually says,
“A child or adolescent with mental illness should be treated in the safest and least restrictive environment and needed services should be ‘wrapped around’ to provide more intensive home or community-based services.”
The rest of the email in response explains why this matters by saying,
“While these two sentences seem to support a less restrictive level of care, when one reads the 207 sentences that follow, it becomes clear that this is a selective reading of the standard in a way that misinterprets it to UBH’s benefit.
The full article provides a detailed explanation of where residential treatment fits within the medical spectrum of care, when an RTC is necessary for a child or adolescent, and what principles should be adhered to when treating children in an RTC setting.
The way that the selection of these two sentences results in a misinterpretation of the standard becomes clear when you review them in the context of the full paragraph:
“A child or adolescent with mental illness should be treated in the safest and least restrictive environment and needed services should be ‘wrapped around’ to provide more intensive home or community-based services. However, due to the severity of an individual’s psychiatric illness, there are times when a patient’s needs cannot be met in a community-based setting. The Child and Adolescent Service Intensity Instrument (CASII; AACAP, 2007) defines level of service intensity by a combination of variables: clinical services, support services, care environment, crisis stabilization and prevention services. When the treating clinician has considered less restrictive resources and determined that they are either unavailable or not appropriate for the patient’s needs, it might be necessary for a child or adolescent to receive treatment in a psychiatric residential treatment center (RTC). In other cases the patient may have already received services in a less restrictive setting and they have not been successful. Psychiatric residential treatment is part of the medical spectrum of care. The array and intensity of services provided in individual residential treatment centers vary greatly. RTCs are programs designed to offer medically monitored intensive, comprehensive psychiatric treatment services for children and adolescents with mental illness or severe emotional disturbance. The assessment of an individual’s appropriateness for treatment within a RTC must include a number of factors, foremost being the child or adolescent’s safety and the safety of others.”
This email explains how the insurance company was trying to pick out the parts that fit their argument the best, instead of doing their job of taking care of their clients. This quote from the article in the email lies in the category of false statement of fact, because they were completely changing what the original article is saying. According to an article written by Constitution Daily, titled, Constitution Check: Is lying ever protected by the First Amendment, “in New York Times v. Sullivan, the Court remarked that “erroneous statement is inevitable in free debate, and it must be protected if the freedoms of expression are to have the breathing space that they need to survive.” This statement is saying that, although this is not enforced in the first amendment, which allows freedom of speech, it would be best if people were not to take advantage of this, by being untruthful.
This explains how insurance companies are refusing to pay for treatment therefore leaving people who need help with paying for treatment to question their decision of placing their kid or themselves in treatment. They instead will ask themselves if they really need it In cases in which they very much do need it. Insurance companies are getting away with not paying for treatment, because the law says that if they have proof that they don’t need it and they don’t have to pay. This means that even if they use false statements of fact, then the insurance company will still win. This is also creating people who need to spend more time on their kids spend time writing claims. If people advocated more for insurance companies to take an equal amount of care for mental health as physical health. It would be very helpful if there were more laws made to make it harder to deny claims. This would make it so that people don’t need to waste their time making multiple nearly perfect claims of second guessing themselves, wondering if they need the treatment.
Bibliography
American psychological association: Affordable health care
Constitution Daily: Constitution Check: Is lying ever protected by the First Amendment
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