Despite the existence of parity1 laws mandating health plans to cover mental ailments comparably to physical ailments, denials and burdensome reviews interfere with treatment. As a practicing physician and mental health advocate, I often find that patients and clinicians are frustrated with barriers to necessary and deserved care.

The same is true across many specialties, and we've probably all heard horror stories of insurance companies denying life-preserving coverage. With mental health, which carries a stigma that already deters people from seeking care, the last thing anyone needs are more hurdles.

Additionally, the common symptoms of mental illness themselves make it hard for patients and families to endure the often long and grueling process of fighting for coverage. Coverage is often denied initially, requiring a protracted appeals process, even engagement of state regulatory bodies. Patients may give up and withdraw from treatment, especially if they have mental health challenges that undermine hope, motivation, and self-esteem.

The peer review process insurance companies use in considering a request for coverage is sometimes smooth but often befuddling. The reviewing doctor is often not a peer; in fact, they may be trained in an entirely different specialty and unqualified to evaluate the treatment plan. The reviewing physician may state that they are not denying the care; they are just saying that the insurance will not pay for it. Of course, such a response is beyond frustrating, because people are often paying a great deal of money up front for insurance coverage; it evokes moral outrage.

Add to that a growing list of whistle-blowers and lawsuits identifying problematic internal policies with insurers. And the slow pace of legislation, regulation, and enforcement, which delays needed treatment while illnesses progress—even if treatment is effective and ultimately covered.

The reality........

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