CBS NEWS - October 22, 2019, 7:46 AM
Every year, an estimated 1 in 5 American adults experiences mental illness. When it comes to insurance coverage, the law is clear. The federal Mental Health Parity legislation passed in 2008 requires health insurers to provide at least equal coverage for mental health conditions, as they do for medical and surgical care. But as CBS News' Dr. Jon LaPook found out, some families still have to fight to get the life-saving care their loved ones need.
In 2013, Brian Cada's 15-year-old daughter Nicole took her own life. A year and a half later, his younger attempted suicide. She was 14.
"She was unable to really process the death of her sister. She kept it inside," Cada said.
Residential treatment was denied. A less intensive level of care was approved.
"The hospital ... said what that translates to is your daughter has not failed often enough to get a longer-term treatment center," Cada said.
After a second suicide attempt, she was approved for residential care. After three weeks there, the clinical staff described "an increase in suicidal ideation," and that she "clearly" met criteria to continue treatment there.
But just a few days later, the insurer, United Behavioral Health (UBH), part of UnitedHealth Group, wrote: "the services asked for are not medically needed."
"They were basically protecting their profitability," Cada said.
Cada could only afford another three weeks.
"It takes time. And because she didn't have that time, she went back into a withdrawal situation," Cada said.
Sylvia Tawse has kept a meticulous record of her son's mental illness and her efforts to get his treatments covered.
"My son was homeless three different times... because he was discharged from the hospital and there was no program for him to go into," Tawse said, adding, "Nine of 10 times, you're getting denied the kind of care that you know your loved one requires."
He has schizoaffective disorder, diagnosed in his teens, and has been hospitalized more than a dozen times. He now works with Tawse and her husband on the family's organic farm. They have depleted their retirement savings paying for his mental health care.
Tawse played us this 2016 voice mail from a care coordinator discussing how many more days would be covered at a residential care facility. "If his symptoms have worsened — " Tawse stopped the tape.
"'If his symptoms have worsened'… they're letting you know the only chance of greater care is if your child's symptoms get worse," Tawse said. "And then you end up... where you're oddly, slightly hoping that something worsens."
"So, you hear the suggestion that your son get Medicaid from the UnitedHealthcare people?" LaPook asked.
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