A few states have passed laws mandating parity for all mental-health treatment, but so far, such a proposal hasn't been seriously considered by Colorado's legislature. (The state parity law does not apply to ERISA self-insured policies. Those plans are covered by the much weaker federal parity law.)
Those who work with consumers trying to get insurers to pay for care say that people who are assertive and take their complaints to a supervisor or medical director are more likely to win appeals.
Hadley Hooper
Phil Anson
Psychologist Ivan Miller says that mental-health patients are targets for HMO cuts.
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"People get really discouraged by this whole process," says Danko. "We're here to help."
The Patient Advocacy Coalition runs a health-rights help line, with trained counselors who help people navigate the appeals process. The coalition is a nonprofit that tries to mediate disputes between patients and insurers, and it is primarily funded by foundation grants. The coalition typically receives at least one call a day from someone with a complaint about mental-health coverage.
While consumers have some ability to challenge insurer denials, it's still an uphill battle. For one former therapist, that was enough to convince him to give up his career.
Mil Hart believed that psychotherapy was much more than just a job. It was a calling, giving him the opportunity to help troubled people. Because he specialized in working with survivors of childhood sexual abuse, he confronted some of the most horrific life stories imaginable. But he found great joy in watching his clients begin to turn their lives around.
"It's heartbreaking to see the damage that sexual violence to children does to people," says Hart. "But it's so wonderful to see people grow out of that damage."
Hart launched his practice in 1992, shortly after earning a master's degree from the University of Northern Colorado. He spent several years building up a practice in Greeley and Fort Morgan. As the years went by, more and more of his clients with insurance were in managed care, and Hart found himself devoting more time to quarreling with insurers and less time to doing the work that he loved.
He had to start justifying every single hour-long session he spent with a client, no matter how desperate the situation. He vividly recalls fighting with an insurance company over care for a woman who had been raped repeatedly by her father.
"They required approval after every four sessions," says Hart. "We had to set standards for what we were going to do. That took one session. Then we'd have two more sessions, then we'd spend the next session talking about what we were going to tell the insurance company. Then we'd have to talk about what the insurance company said. One day I walked into my office, and a voicemail [from the insurer] said, 'We've revoked the four sessions.' It was a bunch of crap."
Meanwhile, Hart's patient worried about whether she would get any treatment at all.
"They were making this poor woman even more crazy. We weren't helping her with her problems," he says.
Most of Hart's clients didn't have enough money to pay for care without insurance. He soon found that one-fourth of his practice was made up of people who couldn't pay at all.
"The most severely damaged people I worked with, I worked with pro bono," he says. "I couldn't turn them away. But to do that, I had to get paid somehow. I'm not talking about getting rich. I'm talking about making a living. I had to take care of my family."
Like other local therapists, Hart spent hours on the telephone with managed-care gatekeepers. Just getting the okay to treat someone was often a struggle, but Hart then found he had to fight to get payments he had already been promised.
"I'd call them, and they'd say they coded it wrong on the computer: In six to eight weeks, you'll get a check.' Then I'd call them six weeks later and get the same story."
A year ago, Hart made a sorrowful decision to give up his practice. He now works in the computer industry.
"It's been a real personal loss not to be doing this anymore, but I had to accept the reality," he says. "If it hadn't been for managed care, I'd still be doing it."
