A panel of health care advocates heard what they already knew Wednesday: that getting access to appropriate mental health and substance abuse prevention programs is no easy task in spite of state and federal parity laws.
Healthcare Advocate Vicki Veltri who chaired the panel of experts at Wednesday’s public hearing said her office sees more cases related to denials of mental health and substance abuse services than any other clinical area.
Perhaps some of the most difficult cases are related to children.
Cathy Morelli, who has a 14 year old daughter with multiple mental illnesses including cutting and an eating disorder, said her insurance carrier Anthem denied her daughter 13 times this year within a five month period of time.
Morelli said the denials were issued “personally” to her daughter, who was hospitalized several times after suicide attempts.
One denial letter from Anthem, which Morelli read into the record, said “you have recently been in a psychiatric hospital for about one month due to behavior problems and trying to hurt yourself. You have had these problems for a long time. You had to go into the medical hospital for a few days and now the medical hospital wants you back in the psychiatric program. You have not been getting better in a significant way for at least the last 30 days. There’s no plan to do anything different. It does not seem likely doing the same thing will help you get better. You need treatment that will likely help you get better.”
“Interestingly Anthem only paid for one day of the 30 days that they speak about in this letter,” Morelli said. “What they fail to mention is that she had a suicide attempt while in-patient at this psychiatric hospital, but in spite of that Anthem still maintained their denial of coverage for her stay there.”
Jody Rowell, a mental health parity advocate in the Office of the Healthcare Advocate, thanked Morelli for her testimony.
“We recognize the human damage that is sometimes done when care is not available or denied,” Rowell said. “I wish I could tell you that you are one in a million as far as being in this position. You’re not and that’s supposed to make you feel better, but it doesn’t.”
In-home services weren’t appropriate for Morelli’s daughter who needed more intensive hospital care, but there are other children which benefit from learning coping strategies in the home.
Dr. Laura Saunders, a child psychologist at the Institute of Living, said there are absolutely no private insurance plans in the state that cover in-home psychiatric services. She said the only carrier that covers it is the state’s Medicaid program called HUSKY.
The only thing she can recommend as a provider is a higher level of care than is medically necessary for a child.
“If you have commercial insurance, we have to automatically divert someone to get voluntary services,“ Saunders said. “The lack of access is very, very unfair to these families with commercial insurance.”
In order to access in-home services families have to get a referral from the Department of Children and Families Voluntary Services division.
She said the in-home service is an absolutely unique service developed by Yale University about 16 years ago. The method is called Intensive In-Home Child and Adolescent Psychiatry Service or IICAPS, and it was recently replicated in New York state.
Veltri wondered if anyone has approached the insurance carriers and asked them to cover this service. No one attending the hearing at the Legislative Office Building could say whether there has been a conversation with carriers to talk about the benefits of the service.
“If someone hasn’t then I think we need to do that,” Veltri said.
She said it’s a more cost effective service delivery model than constant hospitalizations or in-patient psychiatric care for children.
Kevin Galvin, founding chair of Small Business for a Healthy Connecticut, said his health care advocacy wasn’t born out of the Patient and Affordable Care Act, but his experience with his daughters eating disorder.
At the age of 15 one of his daughters was diagnosed with an eating disorder. Although she is better now, Galvin recalled a time when she was constantly in the hospital and near death on at least two occasions.
“I firmly believe that if our insurer would have listened and responded to upwards of a dozen ED experts, and hospitalized my daughter for more than the 28 day normal cycle of hospitalizations that ED suffers get, I would have a far healthier child now,” Galvin said.
But in spite of the insurance companies denials, Galvin was able to win some of the denials on appeal. He also had an unfair advantage. His wife is a certified psychiatrist and pediatrician with working knowledge of eating disorders.
“We has inside clinical knowledge. We had a great network of professionals. We had the best insurance you could get and my daughter almost died,” Galvin said.
The message was well received by the health care advocates on the panel, who will be looking at finding solutions to some of these problems in the future.
“The bottom line is, we have to stand up as a state and pledge to take this on,” said Veltri. “We need to break down the silos in our public and private systems.”
Today’s public hearing was just the first of many Veltri hopes to hold across the state. After receiving more public input she will put together a report with stakeholders to break down some of the barriers to services.