“This was a real surprise,” said the father, who asked to be identified only by his middle name, Paul, to protect his family’s privacy. “They had never seen this before.”
West Virginia lawmakers have since passed legislation requiring parity for coverage for mental health and substance abuse disorders, although the plan covering the doctor still operated under an exemption in the government’s most recent lists. State plan officials did not respond to requests for comment.
Even relatively inexpensive treatment can be hard to get. In Chicago, one of Dr. Michael’s former patients, Julia, whose husband worked for the city and asked not to be identified by her last name to protect her family’s privacy, compared coverage in recent years to treat her anxiety.
In contrast to her previous policy with another Blue Cross plan, a new one overseen by an outside company required cumbersome pre-authorizations for therapy, she said. She had to provide detailed information that formerly had been supplied by her therapist, including the exact diagnosis code and the so-called NPI number used to identify the provider. The company began approving fewer visits at a time, she said.
“It just forces you to jump through the hoops, calling back and keeping track,” she said. If you missed an authorization, you had to pay the full cost of the session.
She also said she was pressured to estimate the length of the treatment or when it might end, a timetable sought in stark contrast to any questions about her other medical conditions. “I don’t have to get my dermatology appointments preapproved,” she said. “Rosea is never going away. No one is asking my dermatologist to cure rosea.”
She stopped therapy when she felt she could adequately manage her condition.
Advocates and patients say that enforcement of the law has often been lax, and that many insurers and employers resist paying for expensive treatments for mental health. But the involvement of both state and federal regulators in the $14 million settlement with United “is very significant,” said D. Brian Hufford, a lawyer with Zuckerman Spaeder, whose firm represented the individuals in the private lawsuits. His firm also represented the plaintiffs in another lawsuit against United that resulted in a 2019 ruling against the company in which a federal judge in Northern California said that one of its units had created internal policies aimed at effectively discriminating against patients to save money. United said the care provided to its customers was appropriate, and the case is now being appealed.
