In the spring of 2023, the behavior of autumutilation and the risk of our daughter became so bad that her doctors recommended admitting it in a short -term residential treatment program. Sending it was the most difficult thing I have ever done. But as a mom and as a doctor, I knew it was the right thing to do, and it literally saved her life.
He also immersed us in a quagmire of health insurance. Our insurer refused to pay for treatment for hospitalized patients and only covered ambulatory services which were only a quarter of the total invoice. They then determined that our daughter did not need additional care even if her medical team – that we paid for ourselves to make additional assessments – found that her mental illness was so serious that she needed long -term care.
Without the help of our insurer, we followed the advice of its doctors and sent it to three additional long -term residential programs. We were fortunate to be able to contract a second mortgage and loans to pay more than $ 350,000.
Unfortunately, many families have equally devastating stories. Insurance companies often interrupt mental health treatment, even when patient policies promise to cover these services.
Fortunately, state legislators have presented legislation, House Bill 1002To ensure that families get mental health care, their premiums are supposed to cover. With a Senate’s vote advances the billHe adopted the Legislative Assembly and was on the office of Governor Jared Polis.
As a person who works daily with insurance companies and has a more in -depth understanding of their operation than most people, I was sure that our insurance scheme would reimburse us for at least part of the services that my daughter received. We therefore worked with billing companies and paid lawyers to represent us. But that didn’t do any good.
After having submitted 1,500 pages of evaluations and professional data, our final call was rejected for lack of evidence that it was a danger to itself. The autumutilation scars of his body have suggested the opposite.
During the same period that my daughter was struggling with her mental health problems, my husband received a diagnosis of amygdal cancer. In contrast striking with the way our insurer had behaved towards our child’s care, his treatment did not have to approve paper trains, no call, no lawyers.
What makes it all the more absurd is that it was in an even more disastrous situation – its survival rate was considered higher that someone with serious mental health problems. Insurers always cover physical health differently from mental health. It makes no sense; Health is health.
Even with this nightmare experience, I know that I am lucky that our family has commercial insurance at all, unlike so many other people. And we had resources to help my daughter get what she needed to prosper again. She is now completely recovered and in her second semester of college. My joyful, intelligent and attentive daughter is back.
But many families in Colorado are not lucky. Some enter an impossible medical debt. Others give up treatment and their conditions worsen and more difficult to approach in the long term. According to a reportMore than 1.1 million coloradans have a diagnosed mental health problem, but only 25.4% which had commercial insurance received specialized care.
It is unacceptable. No family should have to go through what we have or we wonder if their child or their loved ones can access the mental health treatment they need – and who already pay – because their insurance company refuses to cover the costs that their doctors say are necessary.
This is why a law to establish fair standards in mental health care is so desperately necessary. The legislation would establish a standard definition of “medical necessity” so that insurers and doctors use criteria based on accepted clinical evidence. And this will guarantee that carriers really cover the behavioral health and consumption services of medically necessary substances that a doctor has prescribed and which should be covered by the patient’s health plan.
With so many families of our state suffering from mental health problems, but unable to access services due to obstacles to insurance companies, I call the governor to sign this legislation to help coloradans avoid the crushing of medical debt – and save lives.
Dr. Mona Abaza de Denver is a surgeon and a mother and mother.
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