Saturday, July 26, 2014

HUGE Win #4 against my insurance company thanks to the Mental HealthParity Law

Each time our insurance company denies my son the care he needs, and I decide to report them to the CA State Insurance Commissioner for an inappropriate denial, I am stronger and more sure of myself. My immediate cause is more concretely etched in my mind, my words flow more smoothly, and my mind is keen to use any and every possible weapon to support my cause that I can.

My cause is a powerful one. I am a mom fighting for her son's life.

Fortunately, (and in the mysterious ways of the world, plus a caring friend's suggestion), it was put upon my path early in 2014 to attend a NAMI support class with my husband (learn more by clicking here). NAMI stands for the National Alliance on Mental Illness, which is an organization that provides the most up-to-date information on mental illness research and findings. My reasons to explore NAMI were many, but primarily to unite together as a family to be able to best support our son with his terrible depression, and addiction issues. We learned so much from this Family to Family group of classes, connected with others who were going through similar trials with loved ones, and found a new tool box for being able to relate to our son. Also, we found better ways to support our younger son during the regular upheavals our family was going through then, and continues to go through to this day. Our NAMI classes lasted for twelve weeks. We also attended a yearly event put on by NAMI called the "NAMI Walk", where we connected with local organizations offering even more support for families dealing with mental illness, and similar disorders of the brain. Powerful, powerful stuff...

So, NAMI is who I credit for fortifying my head with a whole armory of information that supports individuals with mental illness. This is where I learned about the Mental Health Parity Law.

The Federal Parity Law, which, beginning January 1, 2014, was amended and expanded under the Affordable Care Act. The Mental Health Parity and Addiction Equity Act of 2008 applies to most all forms of health insurance, and states the health plan should provide all medically necessary treatments for severe mental illnesses, including necessary residential care. Mental Health Parity and Addiction Equity information sheet as put out by SAMHSA can be found here.

There was absolutely no reason my son should be excluded from receiving the care he needs, for as long as he needs it. And, even though our insurance plan only covers 100 days of residential care each calendar year, the Mental Health Parity Law allowed for my son's residential care coverage BEYOND the 100 day mark! The cost of residential therapeutic care is so incredibly high, and when a family has basically gone bankrupt due to the high cost of this type of care in an effort to help a family member, it is a huge relief that there are government regulated systems in place so a family can get some sort of a financial break. Our cumulative savings for six months of care at this center were just shy of $100,000! That's ONE HUNDRED THOUSAND DOLLARS.

Wow. Just Wow.

These Laws and systems are available to everyone. Every state has a reporting agency for inappropriate actions taken by insurance companies. If your insurance company denies mental health or addiction coverage for a family member, even if your coverage does not specifically cover that type of care, you can fight this denial! Do not be afraid to ask questions, and stand up when things are not right. I never went into this being a whistle blower. I just know the difference between right and wrong. And, who will stand up for my son, his needs, and his rights, when he cannot do it on his own?

My next step? Becoming involved with NAMI in order to advocate for youth who struggle with Dual Disorders of the brain. I want to support these struggling teens and help their families navigate this difficult road. I am ready. I am willing. I will do what I can.

* To read more about the steps I took to fight my insurance company, please read this post:

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