Consumers And Providers Can Report Abuses By Managed Mental Health Care

http://www.forbes.com/sites/toddessig/2013/03/26/how-consumers-and-providers-can-report-abuses-by-managed-mental-health-care-companies/

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Managed mental health care companies count on the fact that helpless resignation really seems like the best of all possible responses to the decisions they make: patients fear exposing their vulnerabilities to their employers; providers get caught by apathy, and fears of reprisal. Not everyone has the courage to pursue legal action like the plaintiffs in the recent class action filed against UnitedHealth Group alleging, among other things, that United was systematically “undermining access to treatment.”

I am personally no stranger to insurance company induced helplessness, the heavy sluggish weight that descends while being told a standard, empirically-grounded treatment is not consistent with “national standards” and no further appeal is possible for the “adverse care determination.” From the other side I’ve seen patients become fearful and helplessly hopeless after being told treatment they knew to be life-saving was officially deemed “not medically necessary.”

After writing about the class action against United I learned about an alternative to the stark choice of either helpless resignation or courageous legal action. I did not know this previously, but patients and providers can report a company’s potentially illegal actions directly to the Department of Labor. And while, as I also learned, there are several complexities—like this applying only to employer plans with more than 50 employees—the process is doable.

For the last week I’ve had an e-correspondence with Meiram Bendat, both a psychoanalyst and a lawyer who is one of the plaintiff attorneys in the UnitedHealth Group class action. He’s also founder of Psych-Appeal and self-described “persona non grata” with insurance companies. He helped me understand that the DOL web-site allows reports of violations of federal parity laws. As you may know parity laws mandate insurance companies to behave towards mental illness claims as they do towards medical/surgical claims.

I want to be clear that filing a complaint on the DOL web-site titled “Request for Assistance from The Department of Labor, EBSA” (EBSA is the Employee Benefits Security Administration) can seem daunting. But, as I discerned from Mr. Bendat, if you keep the following three points in mind you can make it work...

(article goes on to specific comments about forms and useful language)

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