1. Thread about health insurance companies and mental health "parity," or how my insurance company legally gets away with ignoring parity laws. (Info about parity here: https://www.nami.org/find-support/living-with-a-mental-health-condition/understanding-health-insurance/what-is-mental-health-parity)
2. I am a public employee and have what is considered excellent health insurance, for which both I and my employer pay a great deal of money. Thanks to Chris Christie, it's a GREAT DEAL of money, but that's another story. #stillmad
3. My health insurance company, in accordance with the ACA and NJ state law, provides equal coverage to mental health as to physical health claims. This is called "parity." On paper, there's no difference between a a visit to a psychiatrist and any other type of doctor.
BUT!
4. Most MH practitioners in our area don't deal with insurance. They bill me, I pay them out of pocket, and then I submit the bills to my insurance company. They are supposed to pay 80% of what they consider the correct rate, which is only 60% of the local going rate.
5. So I do the clerical work. I copy, print, snail-mail, and fax. I call, write down reference numbers, and follow up. I do lots of free labor for their company to get my own money back. Why? Because they are forever "losing" our mental health claims and supporting documentation.
6. They have never, in all the years I've had this insurance, "lost" any other kinds of claims. Only mental health claims.
7. Two or three times, I have filed complaints against this company with state authorities. These complaints ALWAYS yield quick, apologetic results from the company and miraculous "findings" of "lost" claims. It's like magic! The threat of state intervention does the trick.
8. The last time I filed one, in 2017, I got a call from an efficient, helpful person I'll call Sara. She apologized, discovered the error the company had made (they had the wrong provider number for the doctor, apparently?), and promised me that all would be well henceforward.
9. She also gave me her number, which I saved in my phone. Good thing! Because they didn't pay a single claim I submitted for 2018. I did the whole routine with the clerical work and reference numbers, waited over 6 months, then remembered to call Sara.
10. Sara asked me to fax her all the old claims, which I did, and she assures me the claims will be processed next week. I also faxed and emailed her all my 2019 claims, which I was holding onto so that they wouldn't get confused.
11. She assures me these will also be taken care of immediately, and that I may send ALL future mental health claims DIRECTLY TO HER! I'm going to get back a few thousand dollars of the many thousands I've already paid the doctor.
12. Two public employee parents could really use the money! Great, right?
13. Except, no. Not really great. I asked her if she could explain what had happened to all my claims, since the error with the provider number had supposedly been cleared up. She can't. No idea. Just send them to her, and they will all be paid promptly.
14. So whatever systemic issue is causing them to "lose" mental health claims, give the elaborate run-around, fail to follow up, put all the burden on patients already stressed with mental health struggles (and their families)--that will all continue.
15. Patients who get frustrated or overwhelmed, give up, lack the resources, and don't know they can file a state complaint online in about ten minutes will keep paying their bills out of pocket, or end up in medical debt. They'll never get to talk to Sara.
16. I'm the squeaky wheel that got the oil. Since Sara told me to submit claims directly to her, I won't experience the run-around in the first place, so I'll never have grounds to file a state complaint again.
17. On paper, they're obeying the mental health parity laws. In reality, they're doing just the opposite. It's the perfect scam, and if they only have to deal with the occasional annoying person who files a state complaint and pay only *her* bills, they are coming out way ahead.
18. So, @njea, how can I help my fellow public school employees and others who have to deal with Horizon with fewer resources than I have? Please let me know, because it's not all about my family. It's about #mentalhealth parity for EVERYONE!
19. And yes, we need universal healthcare that includes mental health services, but while these companies are still working under the current model, let's hold them accountable.
20. P.S. If you are insured in NJ and would like access to this extremely helpful complaint form, here it is: https://sbs.naic.org/solar-web/pages/public/onlineComplaintForm/onlineComplaintForm.jsf?state=NJ&dswid=1096
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