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“It was a real surprise,” said the father, who wanted to be identified only by his middle name Paul to protect his family’s privacy. “They’ve never seen this before.”
West Virginia lawmakers have since passed legislation requiring equivalence for mental health and substance abuse disorders, but the doctor-covering plan still operates under an exemption on the government’s latest lists. State plan officials did not respond to requests for comment.
Even relatively inexpensive treatment can be difficult to obtain. In Chicago, whose husband works for the city, and to protect her family’s privacy, Dr. Julia, one of Michael’s former patients, compared coverage to recent years for treating her anxiety.
He said that unlike his previous policy with another Blue Cross plan, a new plan overseen by an outside company requires cumbersome prior authorizations for therapy. He was required to provide detailed information previously provided by his therapist, including the exact diagnosis code and the NPI number used to identify the provider. He said the company is starting to approve fewer visits at a time.
“It just forces you to jump through hoops, call back and follow,” he said. If you missed an authorization, you had to pay the full cost of the session.
He also said that he was pressured to estimate the duration of treatment or when it might end, in stark contrast to all questions about his other medical conditions, a timeline was sought. “My dermatology appointments don’t need to be pre-approved,” she said. “Rosea will never go away. Nobody asks my dermatologist to treat rosea.”
She left therapy when she felt she could adequately manage her condition.
Lawyers and patients say enforcement of the law is often lax, and many insurers and employers resist paying for expensive treatments for mental health. But D. Brian Hufford, attorney for Zuckerman Spaeder, whose company represents individuals in private litigation, said the involvement of both state and federal regulators in the $14 million settlement with United was “crucial”. His firm also represented the plaintiffs in another lawsuit that was settled against United. 2019 decision Against the company, which a federal judge in Northern California said one of its units had created internal policies aimed at effectively discriminating against patients in order to save money. United said the care provided to its customers was appropriate and the case is being appealed.
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