BrikoXHer Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.
Australis13Honestly, 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.
999 of a 1000 times when they make a decision like this, the patient is fine. This kind of situation is pretty rare. That’s why they do it.
Boot licker.
irotsomaSame 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.
Research doesn’t support that for most people. After 8 to 16 sessions of therapy most people stop making progress. Therapists often like to keep seeing these patients because they’re relatively easy. There’s probably little harm in continuing, except that we’re very short on therapists. So other people that need services can’t get in.
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.
They’re licensed social workers and counselors supervised by a psychiatrist
allegedly
So not the patient’s psychiatrist. Somebody else.
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.
HellsBelleWhere’s your stats and data that back that up??
Narrator: They didn’t have any.
That is utter bullshit.
ApyteleHe’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. 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.
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.
CileTheSaneSource?
“trust me bro”
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.
Likely some internal incentive program that rewards certain minimum rejection rates. Costs following that are counted elsewhere.