Solving The Problem
Mental health care is supposed to be about our wellbeing. But for some insurance companies, it’s about their profit. They keep us from getting the care we need by trapping us in ghost networks, requiring us to fail first with ineffective drugs, and using secret rules about medical necessity. And they make billions every year by doing it.
Ghost Networks
You Need…
To see a therapist.
Your insurance company is supposed to…
Give you a list of providers you can choose from and then pay for your visits.
But instead they…
Trap you in a “ghost network”—a list of providers who aren’t taking new patients, don’t practice anymore, or don’t take your insurance anymore.
What does it mean for you?
You spend hours trying to find a provider and end up with no one to see.
What can we do about it?
Pass a law that forces insurers to keep their network provider lists accurate and up to date.
Fail First
You Need…
The medication your doctor prescribed for you.
Your insurance company is supposed to…
Pay for it.
But instead they…
Make you try—and fail on—different medications before they agree to pay for the one your doctor prescribed in the first place.
What does it mean for you?
You have to take medication that doesn’t work for you, deal with its side effects, and get sicker and sicker.
What can we do about it?
Pass a law that requires insurance companies to cover the medications your doctor orders without delays.
Medical Necessity
You Need…
The treatment your doctor prescribes, like a stay at a residential treatment facility or an intensive outpatient program.
Your insurance company is supposed to…
Help you get the treatment you need from a qualified provider or facility and then pay for it.
But instead they…
Say it’s not “medically necessary” even though your doctor says it is. And they keep the criteria they use to make that decision secret so you don’t even get a real explanation of why they won’t pay for the care you need.
What does it mean for you?
You have to pay for the care you need out of your own pocket—even if it costs tens of thousands of dollars. For so many of us, it means mortgaging our futures, going bankrupt, or going without the care we need and getting sicker and sicker because we can’t pay.
What can we do about it?
Pass a law that requires insurance companies to (1) pay for the care our doctors prescribe and (2) use the same criteria that all the experts—doctors and medical associations—agree on for deciding what mental health and substance use treatment is appropriate.
