I recently joined in on a webinar entitled, “Insurance Companies are Not the Enemy.” I was intrigued by both the title in combination with the fact that the National Eating Disorders Association (NEDA) was presenting this webinar. I admit that I was hopeful that I would learn new information in the webinar, and that I would be enlightened on how insurance companies support and facilitate access to treatment for eating disorders.
Although the purpose of this webinar was to “establish confidence and enable listeners to advocate for themselves,” I was dismayed to find that the presenter displayed a lack of concrete understanding on the deeper matters within insurance policies, as well as the significant impact that widespread insurance denials have on a person trying to recover from an eating disorder.
My experience representing clients who have been denied lifesaving treatment by insurance companies has led me to know that insurance companies often times are the enemy of their members. It is unfortunate, and unnecessary that there be an “us vs. them” mentality, but that is where we are currently. Until insurance companies realize the value of treating people according to the standards of APA treatment guidelines, treating people to outcome, and treating people in a way so that they are well on their way to fully healed by the end of treatment, we will continue to battle.
Regrettably, insurance companies all too often authorize treatment so it is completed as quickly as possible in order to spend as little money as possible. Until this changes, we will continue to battle this enemy of the victims who suffer from a disease they did not choose. Until this changes, we will continue to fight the enemy. We will continue to stand up until the enemy surrenders and covers treatment according to the accepted standards of care for those suffering from eating disorders.
Merriam-Webster defines stigma as: a mark of shame or discredit or an identifying mark or characteristic; specifically : a specific diagnostic sign of a disease. The presenter of this webinar intended to help reduce what he feels is an “us (policyholders) vs. them (insurers.)” stigma. However, my experience leads me to trust that whatever stigma exists against insurance companies has almost certainly been generated by their relentless denials, which repeatedly obstruct access to treatment, and which repeatedly result in increased ER visits, increased returns to treatment, increased relapse, and unfortunately, all too often, an increase in mortality.
I have tirelessly battled insurers’ denials for our clients. What I have found is contrary to what the NEDA webinar displayed. I have found that insurers frequently deny residential treatment for eating disorders based upon these “explanations”:
The decision to approve or deny a claim is made by Medical Reviewers who are identified as “board-certified psychiatrists”, but who typically have ZERO training in eating disorders. Unfortunately, these undertrained medical reviewers are contracted to review cases, and they are contracted to submit their opinion to the insurance company. The opinions of a patient’s treatment team, consisting of eating disorder specialists who work closely with the patient, including their outpatient treatment team, and their family, are all too often disregarded in this decision-making process, and the denial is upheld. It is important for you to know that contrary to what the webinar indicated, medical reviewers are NOT “all mental health professionals.”
Insurance denials create additional emotional and financial stress during an already intense process of recovery. Insurance denials create disruptions in treatment, delays in treatment, inconsistencies in treatment, and oftentimes they create needlessly prolonged treatment, as well as a sense of despair and hopelessness. The webinar stated that insurance representatives are “people that really care about what they are doing.”
And you know what? I agree. I believe that insurance representatives care about what they are doing. However, what they care about is much different than what I care about when it comes to people with eating disorders. Insurance representatives care about the bottom line and saving dollars. It has not been my experience, nor the experience of any of the clients whom we represent, that the insurance company representatives care about their suffering, their well-being, their treatment team’s recommendations, or about how an eating disorder is destroying their life.
We will continue to battle these injustices until not one more person dies because of lack of access to appropriate treatment. As a result of standing up for those who cannot stand up for themselves, and as a result of standing up for what is right and just, I believe a change will happen and insurance companies will realize that denying treatment is an injustice that not only costs them money, but it costs lives. When lives are at stake, we at Kantor & Kantor, LLP will not stand idly by.
Kantor & Kantor, LLP has developed a specialized legal practice representing clients whose claims for treatment of eating disorders and dual diagnosis have been unfairly denied by their health insurers or benefit plan. We spend every working day doing one thing: helping people resolve disputes with their insurance companies so that they might have access to the treatment to which they are entitled. Every single day we are reminded of the devastating impact of an insurance denial, and we diligently battle insurers and advocate for the most appropriate and effective level of care.
