Imagine you have a persistent pain in your knee. That when you walk it constantly aches. That there are days where it’s so painful that it keeps you from going to work or school. Friends and family tell you that it’s time you get help and go see a doctor. Your family doctor refers you to an orthopedist or other specialist. They say that have an injury that you’ll need regular physical therapy, and, in the short term, maybe some medication to manage the pain. Maybe the injury is bad enough that you won’t ever recover 100%, but that you’ll be able to recover enough strength and mobility to walk around and go about your life pretty normally with only occasional discomfort if you put a lot of stress on it running or jumping, but for the most part, it won’t prohibit you from leading a normal life.
Then your insurance company steps in and asks whether you need 50 sessions of physical therapy or twenty five. They question whether you can get by with a limp and a cane- after all, is it really medically necessary that you get back to the point of walking normally? If you’re offended by the suggestion, consider that this is a reality for many facing mental health issues.
In a recent column for Slate Darcy Lockman, a therapist practicing in New York state (where I live), describes the challenges facing her patients. Insurance companies questioning the necessity of certain therapy, the length of time a patient needs or number of sessions they can attend before their share of costs must come out of pocket. I strongly urge you to read the column (rather than me rehashing it point by point).
I shared this article on Facebook yesterday and a friend mentioned that he was thinking of seeing a therapist but wasn’t sure his insurance would cover it. He checked the policy language and, sure enough, it stipulates that the therapy be “medically necessary.” Let me share here what I shared with him- Don’t let insurance policy language scare you off if you think you want to see someone.
You might need a referral from a family doctor, but repeat after me- MENTAL HEALTH CARE IS HEALTH CARE. One of the problems with stigmatizing health care or treating it as a separate kind of care from other routine health care is what causes insurance companies to get away with questioning patients and creates barriers to access for patients. Whether it’s anxiety, knee pain, depression or appendicitis, have a medical professional treat it. More importantly, hold your insurance company accountable- after all, you’re paying for your health insurance, you should be able to use it. If they question your treatment or your condition, complain to your state insurance department or state consumer affairs bureau. The new health care law requires plans to cover mental health as one of ten essential health benefits. It puts mental health on par with other health services as far as treatment options, deductibles, co-pays, etc.
If we cannot hold insurance companies accountable to the terms of the insurance contract, then having a health insurance plan isn’t worth the paper it’s printed on.