Insurance Companies Denying Treatment for the Mentally Ill

Because of recurring tragedies and an increasing number of suicides among the mentally ill, more attention is being paid to the battle that families go through with insurance companies to get their loved one the care that they need. While most routine costs are covered by insurance companies, research has found that the insurance industry often aggressively reviews and denies the costs of chronic cases.

Faceless Insurance Review

Long-term care for the mentally ill is often denied by insurance company doctors who have never even met the patient. As a result, seriously ill patients that have the potential to be a danger to themselves or others are discharged over the objections of their psychiatrists.

The review of long-term mentally ill patients typically goes like this: after a patient is admitted that may need long-term care, an insurance company representative will start to call the doctor every day. Once the insurance representative, and not the doctor, decides that the patient is ready for a lower level of care, the case file is sent to an insurance doctor. The insurance doctor is rarely, if ever, on site to examine the patient and simply calls the on-site doctor to render a judgment. Patients with chronic mental illness are the ones most often denied.

Dealing with Dr. Denial

Looking at one patient who was denied long-term necessary treatment, a psychiatrist working on behalf of the insurance company called the patient’s treatment facility six days into her 90-day treatment three times over the course of 32 minutes. He waited 22 minutes for a call back, and then left a message denying the rest of the patient’s stay. From the first call to denial only took 54 minutes, and the psychiatrist talked to no one.

One of the main reasons for the speedy denial is that insurance company doctors often get paid by the case. One such employee, Dr. Jack, does 550 reviews per month for Anthem Insurance at $45 per patient. Working from home, he makes upwards of $25,000 per month and has a denial rate of 92% for patients. Other insurance doctors had average denial rates as high as 95 or 100%.

An Adversarial Approach

A former medical director of a leading insurance company does not paint a cooperative picture between the care providers and the insurance industry. He claimed that doctors treating the patients will often make things sound more serious than it is in reality, something that care providers adamantly deny. As a result, the relationship between the two industries is often described as adversarial. Unfortunately, when this is the case the patient is often who suffers the most.

Contact a Florida Attorney Today

If you or someone that you know suffers from mental illness and has been denied treatment by their insurance company in the Palm Beach, Broward, Miami-Dade, Martin, or St. Lucie County area, let the experienced attorneys at Gary Roberts & Associates help. Call or contact the office today for a free and confidential consultation of your case.