A successful counsellor is someone who has a mature and balanced state of mind and disposition, who can place themselves in the shoes of others…

You are in our prayers.

Larry Drain
http://www.hopeworkscommunity.com
http://www.hopeworksadvocacy.wordpress.com

I’ve been reading with interest your story dealing with mental health care in CT. I thought you and your readers might be interested in the following resource: http://www.yourcandidatesyourhealth.org is a voter education initiative which asks Congressional and Presidential candidates their stances on health issues, including a question on mental health coverage. Hopefully voters will use this tool to inform themselves about how Representatives and Senators from CT view mental health care….and affect change in the coming years.

In treating people after the Mental Health Parity Law took effect, I’ve learned that this law has more holes in it than Swiss Cheese. I have listed some of the examples:

1. Only some insurance plans contain Mental Health Parity (it excludes private plans, some non-state plans, etc.).

Those with parity:
1. Exclude provider parity, meaning:
a. Providers who haven’t needed the business enough to join the panels will either not be covered, or will be covered with out of network benefits only (instead of major medical full coverage).
b. Providers without the credentials of the medical directors of many plans will be less covered than those with (typically an M.D. or D.O.):
i. For example, MHN (Healthnet) requires paperwork every 10 sessions by non-M.D. providers of mental health, which is time consuming and arduous, disallowing the provider from giving full attention to the actual case and instead focusing on redundant paperwork.
ii. Non M.D./D.O. providers will be reimbursed less in-network, meaning they must see many more patients to make up for this substantial pay reduction (imagine if suddenly your accountant/lawyer/physician got a 50% pay-cut!). And out-of-network, you’ll get less reimbursement, by as much as 50%, making it less affordable to see the more experienced people who typically charge what their M.D./D.O. counterparts charge.

2. Anthem Blue Cross Blue Shield, even Century Preferred, requires even more frequent paperwork, which often can’t be honestly done w/o patient participation, wasting sessions as often as every 4th.

3. I have a Bipolar client whom I saw twice per week, but then her Anthem Century Preferred plan cut it back to once per week. I sought a peer review through the appeals process, but they actually sent it off to non-peers (people w/o my credentials in family therapy) who held up the denial. This goes against my interpretation of the state statute, but the state/insurer was of no help when I alone tried to fight it.

4. I went so far as to go in person, unreimbursed, to the Anthem Medical Director to try and get my services covered better for my client’s Mom, but he denied me parity with people w/his credentials, even though I had much more therapy training (though clearly not medicine training) than most of the psychiatrists. I ultimately decided to give a deal to the clients by conditionally waiving part of their balance, but that then makes it harder on me to give them my all.

5. Quite some time after this incident with Blue Cross, for another client I was seeing under Blue Cross’s contracted out mental health HMO, Value Options, I was audited. I was never told why, but I had to then spend ~50 hours dealing w/the audit process. In the end it was determined that not only did I bill accurately for the mostpart, but where I made errors, I actually underbilled, so in the end Value Options had to send me a check for about $24. So, I earned $.48/hr. from the whole process. Do you have any idea how much good I could have done w/that time for my existing clients if I didn’t go through that audit?

6. Aetna used to cover all providers the same out of network, but in the fall of ‘06 they changed their policy and reimbursed their clients 40% less for the majority of mental health practitioners, w/o regard to the quality and training of those who got the reduction. Even if that saves Aetna $ in the short-run, if people don’t use the best providers as often due to finances, there can be much bigger and more costly problems that can cost Aetna more in the long-term.

7. Utilization management is not or hardly affected by the laws, since insurers can still place policies and do what they want for the mostpart, such as with a Bipolar Disordered person needing hospitalization, the insurer can say if someone isn’t actively trying to kill themselves or others, then they can’t get hospitalization. Sure the patient may attempt suicide and succeed at it a few days later when home at night, but still this is just how it works. Similarly, the insurer can say twice per week therapy only when in a crisis, *as they define it*, which means that the therapist has little to no say in what is defined as a crisis.

8. If you apply for an insurance plan individually, and you’ve had mental health history, most of the plans will deny you.

9. Solutions: I think the two solutions are:
a. Returning to pre-HMO/PPO days to when plans basically covered the coverable services without a a strong discrimination between types of providers. They also allowed more time in hospitals, etc.
b. Change insurance plans to what they were conceived of, at one time, catastrophic coverage. This can reduce premiums paid by individuals/employers, thus allowing more ability of individuals to seek out the healthcare they want. The closest we have are high deductible plans that can combine with a Health Savings Account. This combination gives people the ability to see who they want for how long they want, but the cost is shifted to the patients directly while they save indirectly through lowered priced premiums.

Sam Schaperow, MSMFT, LMFT

My email address is: tar93heel@yahoo.com. Please feel free to email me and hopefully we can meet and help each other out! I am so sorry you have gone through your ordeal with your daughter, and I have also been through the same situation with our son. Please contact the CT Insurance Commissioner’s Office and let them know what happened. Since Bipolar illness is a biological condition, it is covered under what is called parity law. (File a formal complaint against the Insurance company.)

That means that your daughter should have had no problem getting all the medical assistance she needed. A biological illness is one that is something you are born with — in other words — your daughter has no control over having that illness, therefore, health insurance companies must cover the treatments necessary, including, and up to, hospitalization — and not just partial hospitalization!

Hope this helps, and I hope we can talk soon!

Take care, and give your daughter a big hug!

Moosie

Now that things are somewhat better, and I am feeling a little stronger, I may just have to make this my mission to do something about big insurance, government and mental health issues! I could really relate to that guy in New Hampshire who took hostages at Hillary Clintons headquarters in his frustration to get mental health treatment!

There is more, but I dont see an email address to email you.

I keep saying that this should never happen to any family — and yet, it keeps on happening. Unbelievable.

I am missing my husband terribly. I need him, and his strength and warmth and love. I need his feedback on what I do, because he is the consummate “idea man!” He is funny and charming and really, really handsome. He makes me laugh when everything is going wrong, and he counsels me when I am about to make, or am already making, a mistake. He centers me and grounds me, and being without all of those wonderful parts of him for the last several weeks has been very, very difficult.

Sure, talking on the phone several times a day is a huge help, but it will never be the same as when we are together and really there for each other.

Having said all that, though, I still know we are all doing the right thing for our son. Right now, his needs dictate my actions and my husband’s. Until we get our son in a stable, appropriate, and safe environment of his own, I will continue to stay in NC, write letters, and hope that someone out there is listening to this story, and will do something to help.

It would really be so wonderful to hear the words — you can come home and everything is getting arranged for your son. I fear it is becoming a fantasy the longer this goes on.

1. I did leave the state of CT to go to another state to stay with my Mother to get our son off the street and stabilized. I have now been here for a month — separated from my husband, my home, my life. To say this is difficult is a complete understatement. My husband is at risk with his depression, and we are communicating regularly throughout the day, as he struggles with me being gone, and what is taking place at a very slow pace.

2. The staff at Rushford did call in our son’s medications (including one refill), to our local pharmacy in CT. My husband did go and pick them up and has mailed them to us in the other state.

3. Rushford will not continue to prescribe anymore medication over the phone, nor will they give him any therapy over the phone. While you may think that is reasonable, we do not. I am right here with our son, and if any questions needed to be answered or anything else, we could have worked it out. The difficulty with this part of the issue, is that our son has no coverage for medication or physician services while in another state. He has only been able to receive SAGA for the last couple of years, which hasn’t really afforded him any kind of decent health care, let alone mental health care. So, we are in the other state waiting for a Social Security decision, a Title 19 decision, and then a decision from Rushford, and associated agencies, about a proper placement for our son. My mental health providers are doing my therapy over the phone on a weekly basis — and it has been very successful — and it is a great comfort to know that I have their support and guidance while we all go through this. After all, this IS 2007 — NOT 1007! There are all kinds of technology that can be used to facilitate continued and consistent care for a patient that has unusual circumstances! The telephone certainly is not High Technology — but it is still a very powerful and effective tool!

4. The neuro-psychological report was completed, and it really illustrated how our son is severely disabled from his illness, and how he truly needs a supportive, assisted living situation in which to live. I wish desperately that we could give him that situation, but we are only his parents who love him. We are not trained mental health care providers, and we have been beaten down for many, many years by his illness. We have sacrificed our lives on every level imaginable, because we love our son, and we want to hang in there to get him the help he needs. Now, we have to live separate lives for an undeterminate amount of time, until other agencies “get their act together.” My husband and I need each other desperately. We depend on each other for love, support, friendship, and everything else that goes on in a partnership of people who love each other.

I will post more about how this illness has really affected our lives as parents, friends, partners, and lovers, later. As difficult as this is — exposing intimate and very private correspondence and details about our son and family — we simply do not know how else to attack this issue. We are a heartbroken family.