In the spring of 2023, our daughter’s self-harm and risky behavior got so bad that her doctors recommended that we admit her to a short-term residential treatment program. Sending her away was the most difficult thing I have ever done. But as her mom and as a physician, I knew it was the right thing to do, and it literally saved her life.
It also plunged us into a health insurance quagmire. Our insurer refused to pay for inpatient treatment, and covered only outpatient services that was just one quarter of the total bill. They then determined that our daughter did not need further care even though her medical team — whom we paid for ourselves to do additional assessments — found that her mental illness was so severe that she needed long-term care.
Without help from our insurer, we followed her doctors’ advice and sent her to three additional long-term residential programs. We were fortunate enough to be able to take out a second mortgage and loans to pay over $350,000 out of pocket.
Unfortunately, many families have similarly devastating stories. Insurance companies often cut mental health treatment short, even when patients’ policies promise to cover these services.
Fortunately, state lawmakers introduced legislation, House Bill 1002, to ensure families get the mental health care their premiums are supposed to cover. With a Senate vote moving the bill forward, it passed the legislature and is on Gov. Jared Polis’ desk.
As someone who works with insurance companies daily and has a more thorough understanding of how they operate than most people, I was sure that our insurance plan would refund us for at least part of the services my daughter received. So we worked with billing companies and paid for attorneys to represent us. But it did no good.
After submitting 1,500 pages of professional evaluations and data, our final appeal was turned down for lack of evidence that she was a danger to herself. The scars from self-harm all over her body suggested otherwise.
During the same period of time that my daughter was struggling with her mental health issues, my husband was diagnosed with tonsil cancer. In stark contrast to how our insurer had behaved toward our child’s care, his treatment required no reams of paper to be approved, no appeals, no lawyers.
What makes this all the more absurd is that she was in an even more dire situation — his survival rate was considered higher than someone with severe mental health issues. Insurers still cover physical health differently than mental health. It makes no sense; health is health.
Even with this nightmare experience, I know I am fortunate that our family has commercial insurance at all, unlike so many other people. And we had resources to help my daughter get what she needed to thrive again. She is now fully recovered and in her second semester of college. My joyful, intelligent, caring daughter is back.
But many Colorado families are not so fortunate. Some go into impossible medical debt. Others forego treatment, and their conditions get worse and more difficult to address in the long run. According to one report, more than 1.1 million Coloradans have a diagnosed mental health condition, but only 25.4% who had commercial insurance got specialty care.
This is unacceptable. No family should have to go through what we have or wonder if their child or loved one will be able to access the mental health treatment they need — and are already paying for — because their insurance company refuses to cover costs their doctors say are necessary.
That’s why a law to establish fair standards in mental health care is so desperately needed. The legislation would establish a standard definition of “medical necessity” so that insurers and doctors are using criteria based on accepted clinical evidence. And it will ensure carriers are actually covering medically necessary behavioral health and substance use services that a doctor has prescribed and that should be covered under the patient’s health plan.
With so many families in our state suffering from mental health conditions, but unable to access services because of the barriers insurance companies have erected, I call on the governor to sign this legislation to help Coloradans avoid crushing medical debt — and save lives.
Dr. Mona Abaza of Denver is an ear, nose and throat surgeon and mother.
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