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The Battle With Insurance Companies In Mental Illness


Promoting and Proposing Change For Sufferers of Insurance Companies  

This project is a requirement of the GOA Abnormal Psychology Course. Using the process of design thinking, a challenge in the world of mental health was identified, interviews and research were undertaken, and a solution prototype was developed. Below you will find information about the identified area of concern and my proposed solution. Please feel free to provide feedback on this prototype, using questions such as “How might we…”, “What if….?”, “I wonder….”, “I like…”, and “I wish.” Keep the comments positive, please. For more information on the process of Design Thinking, click here.

BACKGROUND:

When beginning our abnormal psychology course, I kept noticing this trend of how many people we’d see with mental illnesses, yet there were so many people untreated. I was really curious as to what were the causes of this and there were so many common causes, such as people not reporting or being bogged down by the stigmas surrounding them, but I wanted to find an outside source actively making receiving care difficult. So, a women named Eden Newmark, whom I have grown close with this past year, agreed to do an interview with me surrounding her work at a Mental Health Institution. When I asked her these questions about what makes it so difficult for some people to get care or for them to provide care, she began relaying the constant struggles they have with insurance companies and getting them to provide the financial backing for care.

 

I began doing more research and kept coming across infographics like the one above, being shocked by how low the numbers were relating to care or treatment. I also wondered (as you can see in the infographic below) how all of these insurance companies could get away with these policies and challenges they make patients go through for treatment with so many laws preventing them from doing so in the ACA and other laws. After hearing the issues Eden faced with insurance companies, I began doing more research and found that there are many loop holes insurance companies go through and how they can make it really hard on families as well, so I knew at this point that was what I wanted to focus my project on.

 

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THE CHALLENGE:

Interviewing A Mental Health Professional…

Recently, I had the opportunity to interview a close friend of mine, Eden Newmark. Eden is the clinical director of The Residential Mood and Anxiety Program at Insight Behavioral Health Center. I spoke on the phone with Eden to get a sense of a day in the life for her, what type of patients she deals with, and most common problems she faces. What stuck out for me the most during our talk, was the most common problem she faced. She said how she is constantly dealing with insurance companies and the back and forth between them can be like “banging your head against the wall to get the proper funding and support for the treatment people need.” She described our medical model in our country as very problem focused and not treatment oriented. I asked Eden what makes dealing with the insurance companies so hard and she said that getting them to appreciate each case individually and not having them be so quick to label someone as a chronic case or just view it as another typical adolescent with depression. Eden then detailed a story to me about a girl they were treating, but needed support from the insurance companies in order to continue her treatment. The story was about a 20 year old girl Eden had recently worked with. The insurance companies labeled her as a chronic case already, at the age of 20. When the companies label someone as a chronic case they become less and less likely to authorize care for a patient and cover treatment. “It was heartbreaking to see someone so young already be labeled as a chronic case,” said Eden. The company was stigmatizing and assuming things about this girl and her treatment, not 100% buying that her failed round of treatment was truly due to genuine mental illness. The issue puts Eden and her organization in an awful spot because the patient is telling them how she doesn’t feel safe and mentions hurting herself, yet the insurance companies are willing to take that risk, which illustrates the self serving tendencies and lack of proper help towards the organization, ultimately putting a patient at risk.   

A family affected…

Listen to the podcast:

 

As you listen, consider:

  • How hard was it made for Natalie to find therapy for her son?
  • Does her story sound like the way it should be for someone looking for treatment for their child?
  • Can you empathize with Natalie and her son from your own experience?
  • Wouldn’t you think someone on a tight budget like Natalie would be receiving extra help form insurance companies because of her financial struggles…?

However, this problem with insurance companies doesn’t stop with mental health organizations and their patients, it hits parents trying to treat their kids with mental health disorders just as hard. There was a podcast and article on NPR telling the story of a single mom, with a child with autism, trying to get therapists for treatment. Natalie Dunnege and her son, Strazh, live in a one-bedroom apartment in San Francisco, CA. Dunnege has struggled for years to get her son proper help from therapists, but hasn’t been able to get the support she needs from the insurance companies. “Under the law, insurance companies can’t charge higher copays or set up separate deductibles for mental health care, compared to other medical or surgical care. They can’t limit hospital stays or require preauthorization for mental health treatment unless the same limits are applied to treatment for physical health conditions. But the laws are complicated and many insurance companies have struggled to comply. In California, state regulators found that 24 of 25 insurance companies offered one or more plans that charged copays or co-insurance for mental health treatments that were higher than the copays or co-insurance required of other medical treatments, even though they are supposed to be the same.” As you can see, the rules that are supposed to be followed by insurance companies to make life for someone like Natalie and her son easier are seldom followed, resulting in the insurance companies benefiting and Natalie and others suffering financially. Natalie’s insurance company, Anthem Blue Cross, charges a $75 copay for a mental health visit, one that is out of her current budget. Blue Cross noted how it, “is committed to providing access to high quality and affordable health care, including mental health care.”But some insurance companies are still finding ways to keep people who need care from getting it — sometimes through subtle, technically legally, ways of limiting treatment. Luckily for Dunnege, she received a promotion and was able to move into a nicer home, lowering her insurance copay to $20, but with that change we see how difficult it is for someone living like Natalie in her old home and how they are basically left to fend for themselves.

 


THE SOLUTION:

Unfortunately, one person can’t fix a problem like this, however, raising awareness and getting people involved in solutions can make a difference. In my interview with Eden, she mentioned that contacting our senators and causing them to be aware of this issue can go a long way. To support families like Natalie’s, we must continue campaigning for the affordable care act and continue to make people aware of these stories and the self serving tendencies of these insurance companies. For someone like Eden and her company, volunteering and fundraising goes a long way for those companies because of how hard it is for them to gather the support from the insurance companies during treatment. For a family like Natalie, campaigning and making the public aware of how the insurance companies have been bending the rules to make someone like Natalie struggle to pay and overpay for the care of her son. Making people aware can bring these issues to the table of senators and legislators that could be the people to spearhead the change that is needed.

In addition, there have been abstract developments to assist people that can’t afford insurance companies stiff prices for care. “Buddy Care” is a virtual emotional assistant powered by AI (Artificial Intelligence) that makes mental healthcare affordable to anyone. As well as helping people who need to someone to talk to, Buddy aims to assist those who can’t get help elsewhere due to insurance companies power. Buddy would allow people suffering from common mental illnesses such as anxiety or depression to have someone to talk to. Below are examples of what Buddy Care aims to achieve and ultimately change:

However, something like Buddy Care has its limits. It can’t assist Mental Health Organizations struggling with insurance companies cooperation or families like Natalie’s, so that is where we need to, as a community, volunteer, share these stories, and get our politicians fighting for what is not only needed, but ethically correct.


WHAT’S NEXT?

  • How can I make people who don’t struggle with insurance companies want to get involved?
  • How can I get more people to share their stories?
  • What other form of awareness would be most successful for this type of challenge?
Which of my three “What’s next?” questions would be the most helpful?

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Other
Please Specify:

Poll Maker

  • My next step will be connecting with Eden again and creating a plan about how I can help their institution’s struggles with insurance companies, with the hope that if it is successful, it could show other companies and people how they can do the same. 

SOURCES CITED:

http://www.npr.org/sections/health-shots/2016/07/25/481765235/single-mom-s-search-for-therapist-hampered-by-insurance-companies

https://uk.pinterest.com/explore/mental-health-statistics/

https://solvecolab.mit.edu/challenges/2016/cure-chronic-diseases/c/solution/1329321

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COMMENTS: 3
  1. April 28, 2017 by Gia DiRubba

    hey nic! I really like how you added the podcast into the project! you did a really good job!!

    • April 28, 2017 by Nic Meister

      Thanks, Gia!

  2. May 02, 2017 by Ryan F

    Hey Nic, I really thought you did a great job on this! You had a lot of interactive information (including the podcast) which made it easy to follow. I really hope to continue to spread awareness!

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